BIA-ALCL diagnosis on CytoLyt fixed ThinPrep,cell block and immunohistochemistry

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an emergent rare T cell non-Hodgkin lymphoma arising in association with a breast implant, particularly textured ones. Recent guidelines list cytopathological examination as the first essential step for diagnosis, routinely followed by CD30 immunohistochemistry (IHC) and flow cytometry (FC) for a T cell clone. The majority of BIA-ALCL literature regarding cytopathological evaluation describes morphology based on various preparation methods limited to cytospins and smears with the exception of at least one case report detailing cytomorphological and IHC findings on ThinPrep. This case report details initial diagnosis of BIA-ALCL rendered with CytoLyt prepared ThinPrep and cell block, including the specific antibodies used for IHC. The ThinPrep slide showed numerous singly dispersed large, atypical cells with abundant cytoplasm containing irregular nuclei with dispersed chromatin and prominent nucleoli in a background of macrophages, inflammatory cells and granular debris. TIA-1 and CD30 along with other T-cell markers, including specific antibodies, remains immunoreactive in tissue collected in CytoLyt solution. Cell size reduction, artifactual lymphoid cell aggregation and prominent nucleoli in benign and reactive conditions are among other ThinPrep cellular alterations pathologists should bear in mind.     

Simultaneous Determination of Cefixime,Cefdinir and Clavulanic Acid by High Performance Liquid Chromatography

Pharmaceutical Chemistry Journal - In this study, two cephalosporin groups of antibiotics (cefepime and cefixime) and their combinations with clavulanic acid, beta lactamase inhibitor, were...     

Endoscopic treatment of primary sclerosing cholangitis.

BACKGROUND/AIMS: Dominant stricture of an extrahepatic bile duct is responsible for symptoms and an exacerbation of cholestasis in 15-20% of patients with primary sclerosing cholangitis. The aim of this study was to evaluate the efficacy and safety of endoscopic treatment in this selected patient group. METHODS: Retrospectively, we evaluated 16 patients who were treated endoscopically due to elevation of serum biochemical liver tests and symptoms which were attributable to dominant bile duct strictures during the period 1990 to 2003. Symptoms and biochemical liver tests were compared before and after treatment. RESULTS: Sixteen patients underwent a total of 58 therapeutic endoscopic retrograde cholangiopancreatographies (ERCP). Sixteen endoscopic sphincterotomies, 15 balloon dilatations, 6 bougie dilatations, 3 stone/sludge extractions and 8 stentings were performed. Endoscopic therapy was technically successful in all patients (100%). Biochemical liver tests were significantly improved when compared with pretreatment values (p<0.001). Patients have been followed-up without stents except for the patients who had cholangiocarcinoma and cirrhosis at the beginning. Procedure-related early complications occurred in 8.6% of therapeutic endoscopic biliary procedures. There was no mortality due to endoscopic treatment. Two patients whose stents were changed every two to three months had cholangitis due to stenting during 13 stent periods. Four patients whose stents were changed in seven to 10 days developed suppurative cholangitis (total 6 stent periods). CONCLUSIONS: Endoscopic therapy of symptomatic dominant strictures in primary sclerosing cholangitis is safe and effective. The cholangitis seen in long-term stenting seems to be solved by short-term stenting.     

Circadian variation of QTc dispersion in children with vasovagal syncope

AIMS: To assess the validity of QTc dispersion to cardiac autonomic nervous function status. METHOD AND RESULTS: Prospective comparisons of QTc dispersion measurements in 77 neurally mediated cardiac syncope (NMCS) patients (29 boys, 48 girls, mean age 13.4+/-0.78) were evaluated. Head-up tilt test (HUT) was positive in 38 patients and negative in 39 patients. QTc dispersion was significantly higher early morning and late night in HUT-positive group compared with HUT-negative group (p<0.001). Although there was a circadian rhythm in HUT-positive group, there was no change on the QTc dispersion within a day in the HUT-negative group. QTc dispersion in the HUT-positive group was high in accordance with their high sympathetic nervous stimulation. Moreover, QTc dispersion was higher during late night and early morning than the rest of the day. CONCLUSION: These results may explain why the HUT-positive patients usually have their syncope attacks early in the morning. Additionally, we can use QTc dispersion measurement as a new noninvasive electrocardiographic test to evaluate cardiac sympathetic nervous system in NMCS.     

Desensitization and internalization of human and xenopus gonadotropin-releasing hormone receptors expressed in alphaT4 pituitary cells using recombinant adenovirus

Nonmammalian vertebrates express at least two forms of GnRH and distinct forms of GnRH receptor (GnRH-R) have coevolved with their ligands. Mammalian and nonmammalian GnRH-R have key structural differences (notably the lack of C-terminal tails in mammalian GnRH-R) and comparative studies are beginning to reveal their functional relevance. However, cellular context and receptor density influence G protein-coupled receptor function and may be important variables in such work using heterologous expression systems. Here we report a comparative study using alphaT4 cells (gonadotrope progenitors that lack endogenous GnRH-R) transfected with a mammalian (human) or nonmammalian (Xenopus laevis type I) GnRH-R. Because conventional transfection strategies proved inefficient, recombinant adenovirus expressing these receptors were constructed, enabling controlled and efficient GnRH-R expression. When expressed in alphaT4 cells at physiological density, these GnRH-Rs retain the pharmacology of their endogenous counterparts (as judged by ligand specificity in radioligand binding and inositol phosphate accumulation assays) but do not activate adenylyl cyclase and are not constitutively active. Moreover, the Xenopus GnRH-R rapidly desensitizes and internalizes in these cells, whereas the human GnRH-R does not, and the internalization rates are not dependent upon receptor number. These data extend studies in COS, HEK, and GH3 cells showing that other GnRH-R with C-terminal tails desensitize and internalize rapidly, whereas tail-less mammalian GnRH-R do not. Retention of these distinctions at physiological receptor density in gonadotrope lineage cells, supports the argument that the evolution of nondesensitizing mammalian GnRH-Rs is functionally relevant and related to the development of mammalian reproductive strategies.     

Quantitative evaluation of right ventricle function by transthoracic echocardiography in childhood congenital heart disease patients with pulmonary hypertension

Introduction and Objective: The present study aims to quantitatively evaluate the right ventricle (RV) function by means of transthoracic echocardiography in normal children and childhood congenital heart disease patients with pulmonary hypertension. Patients and Methods: This study was conducted in a cohort including 40 healthy children and 30 pediatric patients with pulmonary hypertension who were diagnosed under close surveillance at the study center between October 2009 and November 2010. Results: Statistically significant differences were found between the patient and control groups for the right ventricle myocardial performance index (RVMPI), the left ventricle myocardial performance index (LVMPI), the tricuspid valve systolic flow velocity (Ts), the ratio of systolic pulmonary artery pressure to the right ventricle outflow tract systolic flow velocity time integral (sPAP/RVOT VTI), and the ratio of systolic pulmonary artery pressure to right ventricle outflow tract systolic flow velocity time integral × heart rate (sPAP/[RVOT VTI×HR]). When the children were divided into three groups based on their pulmonary vascular resistance significant differences emerged that predicted an increasing severity of RV dysfunction. Significant differences were also observed for the RVMPI, the LVMPI, and the Ts as well as for echocardiographic pulmonary flow (Qp) and systemic flow (Qs). Discussion: The present study demonstrates that echocardiographic parameters can be used for the quantitative detection of RV dysfunction in childhood congenital heart disease patients with high pulmonary artery pressure (systolic, diastolic, and mean) or pulmonary vascular resistance.     

Review of 609 patients with rheumatic fever in terms of revised and updated Jones criteria

BACKGROUND: To investigate the findings and prognosis of rheumatic fever (RF) patients seen in the past 20 years and to compare the last two decades. METHODS: The medical records of all RF patients admitted to Gazi University Department of Pediatric Cardiology during 1982-2002 were reviewed. The decade from 1.1.1982 to 31.12.1991 was designated as 1980s and the following decade as the 1990s. RESULTS: Among the 609 RF cases, there was no difference between the two decades regarding mean age, male/female ratio, most of the minor manifestations and findings of the preceding streptococcal infection. As the rate of carditis declined in 1990s, rates of arthritis and chorea increased. Severity of carditis and admissions with reactivation decreased during 1990s. The two decades did not differ regarding mean age, gender ratio, pericarditis rate, number and type of valvular involvement and sequel of carditis cases. Severity of carditis and number of valvular involvement influenced the first-year prognosis. Almost one-third of the arthritis cases had monoarthritis in both decades. Atypical cases with small-joint involvement were detected number of which increased during the 1990s. CONCLUSIONS: The two decades do not seem to differ regarding most of the manifestations of RF. More emphasis should be given to atypical cases such as small-joint involvement and monoarthritis and silent carditis.