bluuebunny/crossref_metadata_2025 huggingface dataset:
Microsurgical anatomy of the facial nerve trunk
Authors: Salame K. , Ouaknine G.E.R. , Arensburg B. , Rochkind S.
Published: October 2004

Dissection and manipulation of the facial nerve (FN) trunk between its exit from the cranial base through the stylomastoid foramen (SMF) and its bifurcation is a critical step in various otologic, plastic and neurosurgical procedures. This study demonstrates the anatomical relationships and variability of the FN trunk with emphasis on some important morphometric data, particularly with relevance to hypoglossal‐facial nerve anastomosis (HFA). Bilateral microsurgical dissection was performed on twenty‐three human cadavers fixed with formalin. The whole trunk of the FN was exposed, its diameter at the SMF and its length were measured, its branches were observed and the site of its bifurcation was determined. Anastomotic connections with other nerves and blood supply of the trunk were studied. The FN invariably emerged from the cranial base through the SMF. Its diameter upon its emergence from the foramen was 2.66 ± 0.55 mm. Two branches consistently originated from the trunk: the posterior auricular nerve and the nerve to the digastric muscle. Less consistent were the communicating branch with the glossopharyngeal nerve and the nerve to the stylohyoid muscle. The bifurcation of the FN occurred before its penetration into the parotid gland in 15% of cases and within the gland in 85%. The length of the FN trunk was 16.44 ± 3.2 mm. Anastomoses between the FN and other nerves were observed in one‐third of the dissections. The blood supply to the FN trunk was provided by the stylomastoid artery that was identified in 91% of cases. Understanding the microsurgical anatomy of the FN trunk is essential for performing any surgical procedure in the relevant region. Surgical implications of this study are presented with emphasis on HFA surgery. Clin. Anat. 15:93–99, 2002. © 2002 Wiley‐Liss, Inc.
Variability in human quadriceps muscles: Quantitative study and review of clinical literature
Authors: Willan P.L.T. , Ransome J.A. , Mahon M.
Published: October 2004

Knowledge of variations in normal human thigh musculature is important for the interpretation of various clinical and biomedical investigations. In this study, cross‐sections from whole thighs of 34 cadavers were analyzed qualitatively and morphometrically. Sections were cut from right and left limbs at three levels in the region often used for muscle biopsy. Measurements were made of limb circumferences and cross‐sectional areas of the three vasti and of the femur, and of the extent of overlap and fusion between the vasti on the lateral aspect of the thigh. Limb circumference proved to be a good predictor of total cross‐sectional area of the quadriceps muscle. Large individual variations were found for most measurements but especially for the amount of fusion between the muscle bellies of vastus lateralis and vastus intermedius. Significant differences were found for most variables between the three levels, but there were few differences between sides except for the cross‐sectional area of vastus lateralis which was greater on the right at the most distal level. These variations in size and form of thigh musculature should be considered when interpreting data obtained from muscle biopsy, imaging, biomechanical, electromyographic, and functional studies of the human thigh. Review of the literature on variability of quadriceps muscle and its clinical relevance showed a diversity of approaches but insufficient definitive data suitable for interpreting functional outcomes in response to exercise or following surgery. Further work is suggested combining current anatomical datasets with advanced imaging techniques capable of determining muscle fiber orientation and fiber type composition, and including 3D reconstruction. Clin. Anat. 15:116–128, 2002. © 2002 Wiley‐Liss, Inc.
Intramuscular Martin‐Gruber anastomosis
Authors: Rodriguez‐Niedenführ Marc , Vazquez Teresa , Ferreira Bartolome , Parkin Ian , Nearn Lynette , Sañudo Jose R.
Published: October 2004

The incidence and morphology of the intramuscular Martin‐Gruber anastomosis are presented based on the study of 118 human cadavers (55 male, 63 female).

The Martin‐Gruber anastomosis was found in 25 (21.2%) of the 118 cadavers. It occurred in 11 (20%) of the 55 male cadavers (4 bilateral, 7 unilateral; 5 left and 2 right) and in 14 (22.2%) of the 63 female cadavers (2 bilateral, 12 unilateral; 8 left and 4 right). Therefore, the Martin‐Gruber anastomosis was found in 31 (13.1%) of the 236 upper limbs. According to a recent classification (Rodríguez‐Niedenführ et al., 2000), pattern I was found in 29 cases (93.5%), corresponding to Type A in 13 (41.9%), Type B in 3 (9.7%) and Type C in 13 (41.9%), whereas pattern II was found in 2 cases (6.5%), both being a duplication of Type IC. Intramuscular Martin‐Gruber anastomosis was a single anastomosis that originated in all cases from the anterior interosseous nerve (pattern IC) and then passed through a muscle bundle of the flexor digitorum profundus and behind the ulnar artery to join the ulnar nerve as a single connecting branch. It did not send branches to the flexor digitorum profundus. This intramuscular course was observed in 3 of the 13 cases of Type C anastomosis (23.1%) or 3 cases out of 31 Martin‐Gruber anastomoses (10%). Clin. Anat. 15:135–138, 2002. © 2002 Wiley‐Liss, Inc.
Approach to the educational opportunities provided by variant anatomy, illustrated by discussion of a duplicated inferior vena cava
Authors: Zucconi William B. , Guelfguat Mark , Solounias Nikos
Published: October 2004

Variant anatomy recognized during routine cadaveric dissection in the first year of medical school offers great learning potential by allowing students to gain enhanced understanding of an array of important subjects. It provides a framework for reviewing common morphology and embryogenesis of the structure in question, and through the help of appropriate faculty, yields insight into the potential medical, radiologic, and surgical implications. The frequency of clinically important anatomic variation is high enough to allow the gross anatomy laboratory to serve as an excellent teaching platform in this regard. Through anatomy, the student is introduced to the concept of patient individuality, and to the individualization of medical and surgical therapies. Recently, one of the variations encountered in our lab was a duplicated inferior vena cava. We describe our approach to such findings through a systematic discussion of the anatomy and embryology, as well as the radiologic and clinical correlates. Clin. Anat. 15:165–168, 2002. © 2002 Wiley‐Liss, Inc.
Endovascular treatment of the subclavian artery: Stent implantation with or without predilatation
Authors: Amor Max , Eid‐Lidt Guering , Chati Zukai , Wilentz James R.
Published: October 2004

The endovascular treatment of subclavian artery (SA) lesions is less invasive than open surgical repair, with a low rate of complications. We report our experience in 89 subclavian obstructive lesions (n = 86) treated with stenting: 76 (85.3%) stenoses and 13 (14.6%) total occlusions. The left side was most frequently involved (83.1%), localized at the prevertebral segment in 91%. Technical success was obtained in 83 (93.3%) cases, 100% in stenotic lesions and 53.8% in total occlusions. There were nine global complications (10.1%): five (5.6%) at site of puncture, two distal embolization (2.2%), and two (2.3%) major events. The long‐term follow‐up was 3.51 ± 1.98 years, during which time 13 (16.8%) restenoses and 2 (2.6%) reocclusions were noted. Subgroup analysis of patients with stenting after predilatation versus direct stenting technique showed in‐hospital complications only in the first group, with a restenosis rate of 28.5% vs. 4.7%, respectively (P = 0.003). We consider stenting for SA obstructive lesions the first therapeutic option. Cathet Cardiovasc Interv 2004;63:364–370. © 2004 Wiley‐Liss, Inc.
Initial clinical experience with intracardiac echocardiography in guiding balloon mitral valvuloplasty: Technique, safety, utility, and limitations
Authors: Green Nathan E. , Hansgen Adam R. , Carroll John D.
Published: October 2004

The objective of this study was to examine the feasibility and technique of intracardiac echocardiography during percutaneous balloon mitral valvuloplasty. Echocardiographic imaging is commonly used during mitral valvuloplasty. Intracardiac echocardiography is a newer technology that may provide superior imaging during complex valvular interventions. Intracardiac echocardiography and transthoracic echocardiography were performed in 19 patients undergoing percutaneous balloon mitral valvuloplasty. Intracardiac ultrasound images were obtained via the femoral vein in all patients. Imaging projections and catheter locations that were useful for the performance of mitral valvuloplasty were defined. Intracardiac echocardiography guided transseptal puncture, augmented the assessment of valve apparatus deformity, facilitated balloon positioning across the mitral valve, and permitted postprocedural valvular assessment including identification of mitral regurgitation with color Doppler. Intracardiac echocardiography provided essential imaging guidance and procedural monitoring during percutaneous mitral valvuloplasty. Cathet Cardiovasc Interv 2004;63:385–394. © 2004 Wiley‐Liss, Inc.
High‐output congestive heart failure successfully treated with transcatheter coil embolization of a large renal arteriovenous fistula
Authors: Bates Mark C. , Almehmi Ammar
Published: October 2004

Left heart catheterization was performed in response to progressive congestive heart failure of uncertain etiology in a 59‐year‐old male. The coronary arteries were normal but screening abdominal aortography revealed a large arterial venous communication between the left inferior segmental renal artery and the ipsilateral renal vein. The massive size and brisk flow patterns in the fistula presented technical challenges for transcatheter closure. The use of multiple Amplatz vascular obstructive devices (spiders) to create a matrix for securing subsequent coils in staged procedures and the patient's progress following successful closure are discussed. Cathet Cardiovasc Intervent 2004;63:373–376. © 2004 Wiley‐Liss, Inc.
Infective endocarditis after transcatheter closure of a patent foramen ovale
Authors: Calachanis Marco , Carrieri Luisella , Grimaldi Roberto , Veglio Franco , Orzan Fulvio
Published: October 2004

Infection of devices for percutaneous transcatheter closure of atrial septal defects are exceedingly rare. Two cases of device‐associated endocarditis have been reported, which were both operated on. We describe the successful treatment with antibiotics of a device‐associated endocarditis. Catheter Cardiovasc Interv 2004;63:351–354. © 2004 Wiley‐Liss, Inc.
Carotid artery surgery vs. stent: A cardiovascular perspective
Authors: Alhaddad Imad A.
Published: October 2004

Stroke is a major health catastrophe that is responsible for the third most common cause of death and the leading cause of disability. Carotid artery stenosis is an important cause of brain infarctions and the risk of stroke is directly related to the severity of carotid artery stenosis and to the presence of symptoms. Familiarity with different methods of measuring degrees of carotid artery stenosis is a key in understanding the role of revascularization of this disorder. Carotid endarterectomy (CEA), surgical removal of the carotid atherosclerotic plaque, is intended to prevent stroke in patients with carotid artery stenosis and currently the most commonly performed vascular procedure in the United States. Several randomized clinical trials had demonstrated the benefits of CEA in selected groups of patients with symptomatic and asymptomatic carotid artery stenosis. However, CEA can cause stroke, the very thing it intended to prevent, and is associated with significant perioperative complications such as those related to general anesthesia, cardiac or nerve injury. Moreover, several anatomical and medical conditions may limit candidates for CEA. Carotid artery stenting (CS) is an evolving and less invasive technique for carotid artery revascularization. Recent studies demonstrated that CS with embolic protection devices has become an alternative to CEA for high‐surgical‐risk patients and the procedure of choice for stenoses inaccessible by surgery. The role of CS in low risk patients awaits the completion of several ongoing studies. Catheter Cardiovasc Interv 2004;63:377–384. © 2004 Wiley‐Liss, Inc.
Infective endocarditis resulting from CardioSEAL closure of a patent foramen ovale
Authors: Goldstein Jeffrey A. , Beardslee Michael A. , Xu Haodong , Sundt Thoralf M. , Lasala John M.
Published: October 2004

Patent foramen ovale and atrial septal aneurysm are associated with an increased risk of cryptogenic stroke and recurrent thromboembolic events. Percutaneous closure is a therapeutic option to medical therapy and surgical closure. We present the first case of endocarditis associated with a CardioSEAL device closing a patent foramen ovale. Cathet Cardiovasc Intervent 2002;55:217–220. © 2002 Wiley‐Liss, Inc.
The American Cancer Society Cancer Prevention Study II Nutrition Cohort
Authors: Calle Eugenia E. , Rodriguez Carmen , Jacobs Eric J. , Almon M. Lyn , Chao Ann , McCullough Marjorie L. , Feigelson Heather S. , Thun Michael J.
Published: October 2004

BACKGROUND

Large‐scale, prospective cohort studies have played a critical role in discovering factors that contribute to variability in cancer risk in human populations. Epidemiologists and volunteers at the American Cancer Society (ACS) were among the first to establish such cohorts, beginning in the early 1950s and continuing through the present, and these ACS cohorts have made landmark contributions in many areas of epidemiologic research.

METHODS AND RESULTS

The Cancer Prevention Study II Nutrition Cohort was established in 1992 and was designed to investigate the relation between diet and other lifestyle factors and exposures and the risk of cancer, mortality, and survival. The cohort includes over 84,000 men and 97,000 women who completed a mailed questionnaire in 1992. New questionnaires are sent to surviving cohort members every other year to update exposure information and to ascertain new occurrences of cancer; a 90% response rate was achieved for follow‐up questionnaires in 1997 and 1999. Reported cancers are verified through medical records, registry linkage, or death certificates. The cohort is followed actively for all cases of incident cancer and for all causes of death. Through a collaborative effort among ACS national and division staff, volunteers, and the American College of Surgeons, blood samples were collected from a subgroup of 40,000 cohort members and are in storage at a central repository for future investigation of dietary, hormonal, genetic, and other factors and cancer risk. Collection of DNA samples from buccal cells in an additional 50,000 cohort members is underway currently and will be completed in 2002.

CONCLUSIONS

This new cohort of both men and women promises to be particularly valuable for the study of cancer occurrence, mortality, and survival as they relate to obesity and weight change, physical activity at various points in life, vitamin supplement use, exogenous hormone use, other medications (such as aspirin and nonsteroidal anti‐ inflammatory drugs) and cancer screening modalities. Cancer 2002;94:2490–2501. © 2002 American Cancer Society.

DOI 10.1002/cncr.101970
Colorectal carcinoma in poor blacks
Authors: Freeman Harold P. , Alshafie Tarek A.
Published: October 2004

BACKGROUND

Death rates for most cancers continue to be higher for African Americans, particularly those in inner cities. Harlem Hospital serves a poor, predominantly African‐American community in New York City.

METHODS

Tumor registry records for 615 patients treated for colorectal carcinoma at Harlem Hospital between 1973 and 1992 were reviewed.

RESULTS

Of the patients, 45.2% were male and 54.8% female, 97.2% were black, and 82% resided in Harlem. All patients were symptomatic at the time of diagnosis;15.3% were first diagnosed intraoperatively; 8.4% were in American Joint Committee on Cancer Stage I, 20.8% Stage II, 22.8% Stage III, 39.0% Stage IV, and 8.0% could not be staged. Colon resection with intention of cure was performed on 50.6%, 21.5% had palliative resection, and 11.6% had colostomy or other palliative surgery. Adjuvant chemotherapy or radiotherapy was given to 6.2%; 16.9% had no surgical treatment because of advanced stage, poor condition, or refusal of surgery; 12.7% presented with perforation or intestinal obstruction. Operative mortality was 15.3% overall and 10.6% for 311 patients who had surgery with intention of cure. Twenty‐five patients had local recurrence, 86 had subsequent distant metastases, and 33 patients had both local and distant recurrence. Forty‐nine patients (8%) were lost to follow‐up. The 5‐year crude survival rate for 615 patients was 18.7%. The relative survival rate was 19.7%, substantially lower than the national average for the same years.

CONCLUSIONS

Although colorectal carcinoma mortality continues to decline nationally, in this population of poor blacks the mortality rate remained high and unchanged. The most important cause of this is late presentation at an incurable stage, resulting from the combined effects of poverty, lack of education, and lack of access to primary care. Culturally sensitive educational programs and accessible health care systems for the poor are needed. Cancer 2002;94:2327–32. © 2002 American Cancer Society.

DOI 10.1002/cncr.10486
Neutrophilic‐chronic myeloid leukemia
Authors: Verstovsek Srdan , Lin Hui , Kantarjian Hagop , Saglio Giuseppe , De Micheli Daniela , Pane Fabrizio , Garcia‐Manero Guillermo , Intrieri Mariano , Rotoli Bruno , Salvatore Francesco , Guo Jie Q. , Talpaz Moshe , Specchia Giorgina , Pizzolo Gianni , Liberati Anna Marina , Cortes Jorge , Quackenbush Robert C. , Arlinghaus Ralph B.
Published: October 2004

BACKGROUND

Neutrophilic‐chronic myeloid leukemia (CML‐N) has been described as a CML variant associated both with a distinctive molecular defect of the Philadelphia chromosome and with a more benign clinical course than classic CML. The translocation (9;22) in CML‐N results in the transcription of an e19/a2 type BCR/ABL mRNA that codes for a 230‐kD BCR/ABL protein (p230). The indolence of the clinical course of patients with CML‐N has been disputed.

METHODS

The objectives of this study were to quantify and correlate with clinical outcome the p230 mRNA and protein in patients with CML‐N, to describe six new patients and the follow‐up (with molecular analysis) of five previously reported patients with CML‐N, and to review characteristics of all patients with CML‐N and p230 BCR/ABL reported to date in the literature.

RESULTS

Quantitative polymerase chain reaction assays on specimens from the great majority of patients with CML‐N revealed minimal numbers of molecules of p230 BCR/ABL transcripts per total RNA. This also was associated with a lack of detectable p230 BCR/ABL protein in patient specimens, even in one patient who was followed for 16 years after diagnosis. This may explain the milder leukemic phenotype in most patients with CML‐N. A review of all 23 patients who had an e19/a2 type BCR/ABL translocation suggested that the low level of p230 BCR/ABL mRNA and the lack of detectable p230 BCR/ABL protein in patients with no additional cytogenetic abnormalities may predict their indolent clinical course.

CONCLUSIONS

Patients with p230 positive CML‐N have indolent course, probably as a result of low p230 mRNA and protein levels. This supports the need to conduct additional molecular studies, even if cytogenetic studies have revealed t(9;22), because of the prognostic importance of the molecular findings. Cancer 2002;94:2416–25. © 2002 American Cancer Society.

DOI 10.1002/cncr.10490
Molecular events associated with dysplastic morphologic transformation and initiation of ovarian tumorigenicity
Authors: Yang Dong‐Hua , Smith Elizabeth R. , Cohen Cynthia , Wu Hong , Patriotis Christos , Godwin Andrew K. , Hamilton Thomas C. , Xu Xiang‐Xi
Published: October 2004

BACKGROUND

Disabled‐2 (Dab2), a candidate tumor suppressor of ovarian carcinoma, frequently (around 80%) loses its expression in ovarian tumors. Expression of exogenous Dab2 in tumor cell lines negatively regulates growth and suppresses the downstream signal of the Ras/mitogen activated protein kinase mitogenic pathway. The inactivation of Dab2 is believed to be an early event in ovarian tumorigenicity.

METHODS

The authors analyzed the correlation among expression of Dab2, presence of basement membrane (collagen IV and laminin), morphologic alteration of the surface epithelial cells, and expression of the mitotic index marker Mib‐1 in 50 archived ovarian tumors by an immunohistochemical approach. The stainings of Dab2, Mib‐1, collagen IV, and laminin in premalignant lesions bordering both normal and neoplastic ovarian surface epithelium from adjacent slides were analyzed in 50 ovarian tumors.

RESULTS

In these 50 ovarian tumors, the percentage of Mib‐1 positive tumor cells distributed in a wide range, from 1% to 75%, and there has no strong correlation with the expression of Dab2. However, in the premalignant regions bordering tumor and normal ovarian surface epithelium, the loss of Dab2 expression closely correlated with the dysplastic morphologic transition and Mib‐1 expression of the ovarian surface epithelial cells. In 20 foci in 12 out of the 50 tumors, a transition from normal to neoplastic morphology within a contiguous epithelium was observed, and in all cases the morphologic change correlated with the loss of Dab2 staining. In addition, the collagen and laminin staining of the basement membrane were absent or weakened in pre‐malignant epithelium prior to loss of Dab2 expression in all these 20 cases. Nevertheless, collagen IV and laminin were detectable in established adenomas on the same tumor slides.

CONCLUSIONS

The loss of Dab2 is closely associated with the transition of ovarian surface epithelial cells to premalignant states and is likely involved in the initiation of ovarian tumorigenicity. Transient loss of collagen IV and laminin in the basement membrane of the premalignant epithelium and subsequent inactivation of Dab2 are common early events associated with tumorigenicity of the ovarian surface epithelium. Cancer 2002;94:2380–92. © 2002 American Cancer Society.

DOI 10.1002/cncr.10497
Lhermitte sign and urinary retention
Authors: Taieb Sarah , Trillet‐Lenoir Véronique , Rambaud Loïc , Descos Louis , Freyer Gilles
Published: October 2004

BACKGROUND

Regimens combining oxaliplatin with fluorouracil and folinic acid are standard therapeutic options for patients with metastatic colorectal carcinoma. Oxaliplatin has a good safety profile, although it is responsible for dose‐limiting neurotoxicity typically consisting of two distinct clusters of symptoms. Cold‐induced distal paresthesiae occur during or shortly after infusion in most patients and are usually transient and mild. A persistent sensory peripheral neuropathy may develop with prolonged treatment, eventually causing superficial and deep sensory loss, sensory ataxia and functional impairment.

METHODS

The authors report four cases of atypical neurotoxicity induced by oxaliplatin in patients treated for metastatic colorectal carcinoma. Two patients were male and two were female, with an age range of 52–59 years.

RESULTS

Three patients experienced Lhermitte sign and two experienced urinary retention. In all cases, the cumulative dose of oxaliplatin was higher than 1000 mg (range, 1248–2040 mg). Brain and spinal magnetic resonance imaging was performed in two patients and was normal. Somatosensory evoked potentials were recorded in two patients and suggested cervical dorsal column dysfunction. Symptoms resolved a few weeks after discontinuation of oxaliplatin.

CONCLUSIONS

Lhermitte sign may be induced via a neurotoxic effect on the ascending axons of these T‐shaped neurons. An atonic bladder may be the result of damage to the sensory portion of the sacral reflex arc, either in the dorsal roots, as for example in diabetic neuropathy, or in the posterior columns, as in tabes dorsalis. Alternatively, it may result from a paralysis of the parasympathetic fibers that control the bladder musculature. It is unclear at present whether the micturition difficulties observed in patients in the current series are due to sensory neuropathy or to autonomic neuropathy, event if the former hypothesis seems more likely, as autonomic neuropathy has not been previously observed with oxaliplatin, and its association with cisplatin is exceedingly rare and controversial. Cancer 2002;94:2434–40. © 2002 American Cancer Society.

DOI 10.1002/cncr.10500
Motor nervous system impairment persists in long‐term survivors of childhood acute lymphoblastic leukemia
Authors: Lehtinen Satu S. , Huuskonen Usko E. , Harila‐Saari Arja H. , Tolonen Uolevi , Vainionpää Leena K. , Lanning B. Marjatta
Published: October 2004

BACKGROUND

The objective of the current study was to determine whether therapy for childhood acute lymphoblastic leukemia (ALL) results in long‐lasting neurologic signs or electrophysiologic injuries within the motor tracts.

METHODS

Twenty‐seven children who were treated for ALL were studied clinically 5 years after the cessation of therapy by means of motor‐evoked potentials (MEPs) elicited by magnetic stimulation transcranially and peripherally. An equal number of healthy children matched with regard to age, gender, and height served as the control group.

RESULTS

The MEP latencies to the hands and legs elicited by stimulation at the cortex were prolonged significantly in the children treated for ALL compared with the control group, with the differences being 2.2 milliseconds [ms] (P < 0.001) from the cortex to the thenar on the right side and 2.0 ms (P < 0.001) on the left, and 1.4 ms (P = 0.004) from the cortex to the leg on the right side and 1.3 ms (P = 0.004) on the left. Correspondingly, the MEP latency from the fifth lumbar vertebrae (LV) level to the leg also was prolonged, by 1.0 ms (P = 0.005) on the right side and 0.8 ms (P = 0.005) on the left side. The calculated latency between the cortex and the LV level was not found to be significantly longer in those patients treated for ALL compared with the healthy controls. Neurologic signs, in the form of depressed deep tendon reflexes, were observed in 8% of the patients, whereas approximately 33% of the patients were found to have fine or gross motor difficulties and dysdiadochokinesia.

CONCLUSIONS

Neurologic signs still persisted 5 years after therapy for ALL. Approximately 33% of the patients had fine or gross motor difficulties and dysdiadochokinesia, and demyelinative injuries to the peripheral nerve tracts were found proximally but not within the central nervous system. Cancer 2002;94:2466–73. © 2002 American Cancer Society.

DOI 10.1002/cncr.10503
Tumor volume as a prognostic factor for sarcomatosis
Authors: Bilimoria Malcolm M. , Holtz Daniel J. , Mirza Nadeem Q. , Feig Barry W. , Pisters Peter W. T. , Patel Shreyaskumar , Pollock Raphael E. , Benjamin Robert S. , Papadopoulos Nicholas E. , Plager Carl , Murphy Anne , Griffin Janet R. , Burgess Michael A. , Hunt Kelly K.
Published: October 2004

BACKGROUND

The appropriate therapeutic interventions for sarcomatosis, or sarcoma characterized by intraabdominal dissemination, remain unclear. The authors performed a retrospective analysis of their recent experience with patients diagnosed with sarcomatosis to determine the overall survival and the effects of clinicopathologic features on survival rates at two and four years.

METHODS

A query of the authors' prospective soft tissue sarcoma database identified 51 patients with a diagnosis of sarcomatosis who were evaluated at the authors' institution between June 1996 and June 1999. Clinical and pathologic factors were evaluated, and survival was calculated using a Kaplan‐Meier survival analysis. Disease was categorized as low or high volume based on findings at surgical exploration or computed tomography scan evaluation. Disease was classified as low/intermediate grade or high grade based upon histologic examination.

RESULTS

Twenty five patients were male and 26 were female. The median time from the initial diagnosis of sarcoma to the development of sarcomatosis was 0.9 years (range, 0‐26 years). Thirty nine patients were treated with surgery, whereas 32 received primarily nonsurgical treatment. Histology revealed gastrointestinal stromal tumor (GIST) in 33 patients and other histologies in 18 patients. The two year overall survival rate of patients with GIST was similar to that of patients with other types of sarcoma (38% versus 42%, respectively, P = 0.77). Patients with low volume disease had an overall two year survival rate of 82%, compared with only 24% for patients with high volume disease (P = 0.008). There was no difference in the overall survival rates of patients with low grade (n = 18) versus high grade tumors (n = 33, P = 0.29). With a median followup of 2.7 years (range, 0.5–26.4 years), the median time from sarcomatosis to death was 13 months (range, 4–42 months).

CONCLUSIONS

Evaluating volume of disease at the time of diagnosis permits stratification of patients into prognosis based subsets. We found no significant difference in two or four year survival rates in patients with GIST and those with non‐GIST sarcomatosis. Cancer 2002;94:2441–6. © 2002 American Cancer Society.

DOI 10.1002/cncr.10504
Clinical relevance of fatigue levels in cancer patients at a Veterans Administration Medical Center
Authors: Hwang Shirley S. , Chang Victor T. , Cogswell Janet , Kasimis Basil S.
Published: October 2004

BACKGROUND

The correlation of fatigue levels with functional interference, symptom distress, and quality of life may help determine clinically significant fatigue levels.

METHODS

One hundred eighty consecutive patients with cancer completed the Functional Assessment of Cancer Therapy (FACT) General and Fatigue subscales (FACT‐G and FACT‐F, respectively), the Memorial Symptom Assessment Scale‐Short Form (MSAS‐SF), the Depression Scale (Zung), and the Brief Fatigue Inventory (BFI). The Karnofsky performance status (KPS) was determined for each patient. Multivariate analyses of variance were performed to compare fatigue models with different cut‐off points to categorize fatigue levels. Cox proportional hazards analysis was performed to assess the association between fatigue severity and survival.

RESULTS

Increased fatigue levels were associated with greater symptom distress and decreased quality of life. A model with usual fatigue cut‐off points of 0 (no fatigue), 1–2 (mild fatigue), 3–6 (moderate fatigue), and 7–10 (severe fatigue) was optimal in relation to functional interference items (Wilks λ, 0.36; F = 11.61; P < 0.0001), symptom distress scores (Wilks λ, 0.52; F = 10.41; P < 0.0001), and quality‐of‐life scores (Wilks λ, 0.50; F = 0.50; P < 0.0001). Fatigue severity predicted survival in univariate analysis (chi‐square test, 25.42; P < 0.0001). The KPS, stage of disease, and number of symptoms independently predicted survival in patients with fatigue.

CONCLUSIONS

Clinically relevant fatigue levels are correlated with symptom and quality‐of‐life measurements. Patients with a usual fatigue severity > 3 or a worst fatigue severity > 4 on a 1–10 scale may require further assessment. Cancer 2002;94:2481–9. © 2002 American Cancer Society.

DOI 10.1002/cncr.10507
Paclitaxel, carboplatin, and topotecan in the treatment of patients with small cell lung carcinoma
Authors: Hainsworth John D. , Morrissey Lisa H. , Scullin Daniel C. , Ann Houston Gerry , Prasthofer Edgar F. , Gray James R. , Burris Howard A. , Greco F. Anthony
Published: October 2004

BACKGROUND

The objective of this study was to evaluate the feasibility, toxicity, and efficacy of a novel three‐drug regimen containing paclitaxel, carboplatin, and topotecan followed by oral etoposide in the first‐line treatment of patients with small cell lung carcinoma.

METHODS

One hundred five patients with previously untreated, limited stage or extensive stage small cell lung carcinoma were treated in this multicenter, community‐based, Phase II trial. All patients received paclitaxel 135 mg/m2 by 1‐hour intravenous (IV) infusion on Day 1, carboplatin at an area under the serum concentration‐time curve of 5.0 IV on Day 1, and topotecan 0.75 mg/ m2 IV on Days 1–3. The treatment regimen was repeated at 21‐day intervals for 4 courses. Patients with limited stage disease also received radiation therapy (45 grays [Gy]; in single daily fractions of 1.8 Gy) beginning concurrently with the third course of chemotherapy. Patients who had an objective response or stable disease after 4 courses of combined paclitaxel, carboplatin, and topotecan then received 3 courses of oral etoposide (50 mg alternating with 100 mg for 10 consecutive days) repeated at 21‐day intervals.

RESULTS

Treatment with paclitaxel, carboplatin, and topotecan produced response rates of 88% and 93% in patients with extensive stage disease and limited stage disease, respectively. The median survival for patients with extensive stage and limited stage disease was 8.3 months and 17.2 months, respectively. The addition of oral etoposide was feasible, but there was no suggestion that it prolonged remission. This three‐ drug regimen was associated with acceptable toxicity in patients with a good performance status, although it was tolerated very poorly by patients with an Eastern Cooperative Oncology Group performance status of 2; 5 of 12 patients (42%) had treatment‐related deaths.

CONCLUSIONS

Although this three‐drug regimen was active in the treatment of patients with small cell lung carcinoma, it was more toxic than standard platinum and etoposide regimens and provided no apparent improvement in efficacy. Further investigation of topotecan as a component of first‐line therapy should focus on two‐drug combination regimens in which the topotecan dose can be optimized. Routine use of three‐drug regimens in patients with small cell lung carcinoma should await demonstration of superiority in randomized trials. Cancer 2002;94:2426–33. © 2002 American Cancer Society.

DOI 10.1002/cncr.10508
Nucleus isthmi, pars semilunaris as a key component of the tectofugal visual system in pigeons
Authors: Hellmann Burkhard , Manns Martina , Güntürkün Onur
Published: October 2004

The avian isthmic nuclei are constituted by a group of structures reciprocally connected with the tectum opticum and considered to play a role in the modulation of intratectal processes. Although the two larger isthmic nuclei, the n. isthmi pars parvocellularis (Ipc) and the n. isthmi pars magnocellularis (Imc), have been studied in detail previously, the third and smallest of this group, the n. isthmi pars semilunaris (SLu), has been largely neglected. The present study demonstrates this isthmic component to be characterized by a unique connectivity and immunohistochemical pattern: 1) SLu receives tectal afferents and projects back onto the outer retinorecipient tectal layers; 2) it projects bilaterally onto the nucleus rotundus and thus modulates the ascending tectofugal system; 3) in addition, previous studies have demonstrated SLu projections onto the lateral spiriform nucleus (SpL), which mediates basal ganglia output onto the tectum. In that SpL projects onto the deep layers of the tectum, SLu indirectly modulates descending tectal output patterns. Taken together, the role of SLu goes far beyond a local modulation of intratectal processes. Instead, this isthmic structure is likely to play a key role in the topographically organized modulation of the ascending and, at least indirectly, also the descending projections of the optic tectum. J. Comp. Neurol. 436:153–166, 2001. © 2001 Wiley‐Liss, Inc.
Palladin is expressed preferentially in excitatory terminals in the rat central nervous system
Authors: Hwang Se Jin , Pagliardini Silvia , Boukhelifa Malika , Parast Mana M. , Otey Carol A. , Rustioni Aldo , Valtschanoff Juli G.
Published: October 2004

Palladin is a recently described intracellular protein associated with the actin cytoskeleton and cell adhesion in fibroblasts. In Western and Northern blot analyses, palladin expression is ubiquitous in embryonic mice, but it is down‐regulated dramatically in most adult tissues. Significant amounts of palladin persist in the brain of adult rodents, as assessed by Western blot analysis. With this work, we extend preliminary observations and determine the overall distribution and subcellular location of palladin throughout the rat brain. In sagittal and coronal sections of the central nervous system, immunostain for palladin is present throughout the brain and spinal cord, but not uniformly. The densest regions of immunostain include the olfactory bulb, cerebral and cerebellar cortex, hippocampus, amygdala, superior colliculus, and superficial laminae of the spinal dorsal horn. Because immunostain characteristically is punctate, we performed double staining for palladin and the presynaptic marker synaptophysin. Confocal microscopy showed that palladin‐immunopositive puncta are also immunopositive for synaptophysin; the proportion of synaptophysin‐immunopositive puncta that also stained for palladin ranged from 100% of mossy fiber terminals in field CA3 of the hippocampus and in the cerebellar cortex to 60–70% of terminals in the cerebral cortex, striatum, and spinal dorsal horn. The presence of palladin in synaptic terminals was confirmed by electron microscopy. Because immunostained terminals commonly establish asymmetric synapses, the selectivity of palladin expression in synaptic terminals was tested by double staining for palladin and γ‐aminobutyric acid. The modest level of colocalization in this material at both the light microscopic and electron microscopic levels suggests a selectivity of palladin for terminals that release excitatory neurotransmitters. As concomitant work in cell cultures has shown that palladin participates in axonal development and migration, the present results suggest that palladin persists at excitatory synapses of the adult nervous system. J. Comp. Neurol. 436:211–224, 2001. © 2001 Wiley‐Liss, Inc.
Development and reorganization of corticospinal projections in EphA4 deficient mice
Authors: Coonan Jason R. , Greferath Ursula , Messenger Jonathan , Hartley Lynne , Murphy Mark , Boyd Andrew W. , Dottori Mirella , Galea Mary P. , Bartlett Perry F.
Published: October 2004

The Eph family of receptor tyrosine kinases and their ligands, the ephrins, are important regulators of axon guidance and cell migration in the developing nervous system. Inactivation of the EphA4 gene results in axon guidance defects of the corticospinal tract, a major descending motor pathway that originates in the cortex and terminates at all levels of the spinal cord. In this investigation, we report that although the initial development of the corticospinal projection is normal through the cortex, internal capsule, cerebral peduncle, and medulla in the brain of EphA4 deficient animals, corticospinal axons exhibit gross abnormalities when they enter the gray matter of the spinal cord. Notably, many corticospinal axons fail to remain confined to one side of the spinal cord during development and instead, aberrantly project across the midline, terminating ipsilateral to their cells of origin. Given the possible repulsive interactions between EphA4 and one of its ligands, ephrinB3, this defect could be consistent with a loss of responsiveness by corticospinal axons to ephrinB3 that is expressed at the spinal cord midline. Furthermore, we show that EphA4 deficient animals exhibit ventral displacement of the mature corticospinal termination pattern, suggesting that developing corticospinal axons, which may also express ephrinB3, fail to be repelled from areas of high EphA4 expression in the intermediate zone of the normal spinal cord. Taken together, these results suggest that the dual expression of EphA4 on corticospinal axons and also within the surrounding gray matter is very important for the correct development and termination of the corticospinal projection within the spinal cord. J. Comp. Neurol. 436:248–262, 2001. © 2001 Wiley‐Liss, Inc.
Localization and quantification of 5‐hydroxytryptophan and serotonin in the central nervous systems of Tritonia and Aplysia
Authors: Fickbohm David J. , Lynn‐Bullock, Christina P. , Spitzer Nadja , Caldwell Heather K. , Katz Paul S.
Published: October 2004

Serotonin (5‐hydroxytryptamine, 5‐HT) plays a central role in several behaviors in marine molluscs and other species. In an effort to better understand the regulation of 5‐HT synthesis, we used high performance liquid chromatography (HPLC) with electrochemical detection and immunohistochemistry to measure and map the distribution of the immediate precursor of 5‐HT, 5‐hydroxytryptophan (5‐HTP), in two model opisthobranch molluscs, the nudibranch Tritonia diomedea and the anaspid Aplysia californica. HPLC measurements showed that 5‐HTP is present at approximately the same level as the 5‐HT metabolite, 5‐hydroxyindolacetic acid (5‐HIAA) but is more than 100 times lower in concentration than either 5‐HT or dopamine in the same tissue. Specific 5‐HTP immunoreactivity was colocalized with serotonin in both species. The overall intensity of 5‐HTP immunoreactivity in individual ganglia agreed with HPLC measurements for those ganglia. The intensity of 5‐HTP immunolabeling varied between cell types and was correlated with the intensity of 5‐HT immunolabeling. In particular, differences in staining intensity were consistently seen among the three dorsal swim interneurons of the Tritonia swim central pattern generator circuit. Some nonserotonergic neurons also displayed low levels of 5‐HTP immunolabeling that were above background levels. Together, these results support the notion that production of 5‐HTP is a rate‐limiting step in serotonin synthesis and suggest that there may be additional regulation that allows 5‐HTP to accumulate to varying levels. J. Comp. Neurol. 437:91–105, 2001. © 2001 Wiley‐Liss, Inc.
Fine‐needle aspiration cytology and differential diagnoses of fibrolamellar hepatocellular carcinoma metastatic to the mediastinum: Case report
Authors: Sarode Venetia R. , Castellani Rudy , Post Anthony
Published: October 2004

We report a case of fibrolamellar hepatocellular carcinoma (FL‐HCC) that metastasized to the posterior mediastinum. The diagnosis was made on fine‐needle aspiration biopsy (FNAB). The cytologic features were characterized by the presence of large, dishesive, polygonal cells with granular cytoplasm and well‐defined cell outlines resembling oncocytes. Groups of neoplastic hepatocytes containing bile pigment were also noted. The diagnosis of FL‐HCC in a metastatic site can pose diagnostic challenges on FNAB. The cytologic features overlap with a variety of tumors that have oncocytic features and also with melanoma and paraganglioma. Recognition of specific cytologic features of FL‐HCC can facilitate accurate diagnosis in a metastatic site. The cytologic findings and differential diagnoses of FL‐HCC that metastasized to the posterior mediastinum are discussed. Diagn. Cytopathol. 2002;26:95–98; DOI 10.1002/dc.10047 © 2002 Wiley‐Liss, Inc.
Wilms' tumor in adults: Aspiration cytology and cytogenetics
Authors: Li Peng , Perle Mary Ann , Scholes John V. , Yang Grace C.H.
Published: October 2004

The fine‐needle aspiration cytologic findings of Wilms' tumor occurring in a 20‐yr‐old female patient and a 35‐yr‐old male patient showing blastemal, spindled sarcomatous and rare epithelial components are reported. The male patient had the typical presentation of renal mass with metastasis to lung and pleura, whereas the female patient had an unusual presentation with the tumor originated from the subcapsular nephrogenic zone of the kidney, extending into the liver without invasion into the renal cortex. Cytogenetic analysis of this case identified: 90, XXXX, +2x3∼4, ‐5, ‐15, ‐16, ‐17, ‐17, i (17)(q10) x2. This finding may represent a genetic change associated with Wilms' tumor of older pediatric and young adult patients. To the best of our knowledge, this case is the sixth case with cytogenetic study and the first case revealing isochromosome 17q of an adult Wilms' tumor. Diagn. Cytopathol. 2002;26:99–103; DOI 10.1002/dc.10048 © 2002 Wiley‐Liss, Inc.
Comparative cytological study of lymph node tuberculosis in HIV‐infected individuals and in patients with diabetes in a developing country
Authors: Sridhar C.B. , Kini Usha , Subhash Kavitha
Published: October 2004

Tuberculosis (TB) is a common infection affecting patients with human immunodeficiency virus (HIV) and diabetes mellitus (DM). With the increasing incidence of HIV infection and DM in a developing country like India, TB is definitely on the rise. In a given population, one expects to see these three diseases in varying combinations, such as HIV and TB, DM and TB, HIV and DM with TB. In such combinations TB may lack the characteristic clinical and histological picture due to the associated depressed cell‐mediated immunity seen in both diseases and TB may have an unusual clinical presentation and cytology picture. In this retrospective study of 36 months, from January 1997 to December 1999, 109 cases diagnosed cytologically as tuberculous lymphadenitis and tested for HIV infection and investigated as well for DM were selected. Forty‐six (42%) were nondiabetic HIV patients, 13 (12%) were non‐HIV DM patients, and 50 (46%) had TB without HIV infection or DM. The coexistence of both HIV and DM was not noted. The cytomorphological characteristics supplemented by culture studies of each of these three groups were compared in detail and based on these four cytological patterns, Pattern 1, Pattern 2, Pattern 3, and Pattern 4 emerged and were characterized. This study highlights the usefulness of cytomorphology of the lymph nodes to characterize the cytopathological profile of TB in both HIV and DM, which have many clinical and immunological similarities, and indirectly postulate the extent of immune suppression and evolve effective strategies in the management of coexisting diseases. Such a comparative study has not been carried out in the past. Diagn. Cytopathol. 2002;26:75–80; DOI 10.1002/dc.10059 © 2002 Wiley‐Liss, Inc.