The endoscopic management of inverted papilloma has gained increasing popularity over the last 10 years. Although early concerns over an increased risk of recurrence seem to have been allayed, the ...appropriate management of lesions involving the frontal sinus and frontal recess still has to be determined.
We performed a retrospective review of the results of all patients with inverted papilloma from 2000 to 2004.
A total of 18 patients were treated between October 2000 and January 2004. Six patients had frontal sinus involvement at the time of initial evaluation. One of these patients had isolated frontal sinus involvement. These patients were managed with either initial endoscopic resection with determination for the need for an additional procedure at the time of endoscopic resection (n = 5) or open/endoscopic approach for isolated frontal sinus involvement (n = 1). Of the five patients who had their disease managed endoscopically, three patients were determined at the initial procedure to need an osteoplastic flap and, subsequently, were managed successfully with a combined approach. One other patient was initially successfully managed endoscopically but ultimately required an osteoplastic flap for definitive management. The fifth patient was managed entirely endoscopically with multiple procedures. All patients treated with this protocol remain disease free with an average follow-up of 13.3 months.
The limitations of endoscopic resection of inverted papilloma of the frontal recess can be managed with staged procedures. Initial endoscopic resection of ethmoid/maxillary disease with subsequent open treatment of the frontal sinus has been successful in our experience.
Computer assisted image analysis was used to determine quantitative and reproducible nuclear morphology of 17 totally excised pathological specimens from stage B-2 prostatic cancer in an attempt to ...correlate histopathological analysis with clinical prognosis for the individual patient. We describe a nuclear roundness factor that correlates with the clinical outcome of the individual patient. This nuclear shape factor appears to identify prostatic tumors with a high metastatic potential from tumors that are less aggressive. Quantitative nuclear image analysis, its accuracy, and reproducibility are described and discussed. This technique may provide the pathologist with a valuable tool for analyzing prostatic cancer cells in a quantitative manner, thereby contributing precise information to the urologist relevant to the prognosis of the individual patient.
Dural arteriovenous fistulas (DAVFs) comprise 10% to 15% of all arteriovenous malformations. Recent studies have demonstrated promising results when radiosurgery is used for DAVFs. We retrospectively ...analyzed our patients with DAVFs who received stereotactic radiosurgery with or without embolization.
Between 1991 and 2002, 18 patients with 23 angiographically confirmed symptomatic DAVFs underwent gamma knife radiosurgery, either alone (n = 8) or in combination with embolization (n = 10). A retrospective chart review was performed to identify DAVF location, venous drainage pattern, radiosurgery dosimetry, clinical outcomes, and imaging results. The series included 9 men and 9 women with a mean age of 65 (range 50-89) years. Nine patients received particulate, coil, and/or absolute ethanol embolization before radiosurgery, and 1 patient received particulate embolization after radiosurgery. The mean duration of clinical follow-up was 43 (range 2-116) months. The mean margin radiosurgery dose was 20 (range 15-30) Gy.
Nine patients had complete resolution of their presenting symptoms, and 9 patients had resolution of all but 1 of their presenting symptoms. Angiographic follow-up (mean 46 months) was performed on 8 patients demonstrating complete obliteration in all the cases. Seven patients evaluated by magnetic resonance angiography or computed tomography angiography showed no evidence of DAVF (4 patients) or decreased DAVF size (3 patients). After radiosurgery, 1 patient developed a temporary hemiparesis. Two permanent neurological deficits occurred after embolization before radiosurgery. No patient had an intracranial hemorrhage after treatment.
Stereotactic radiosurgery provides effective long-term relief of symptoms in selected patients with DAVFs.
...the need to take a British study beyond the pilot phase may not be supported. 4 Be that as it may, an important issue was not addressed in the BMJ. When several units can be compared over time, a ...benchmark might be established for the optimal level of reporting, which will never be the lowest. ...a benchmark is established, anybody publishing such information should explain prominently in the introduction that there is no standard yet, and the contrary effects on the apparent frequency of incidents of honest reporting and good practice mean that no league tables can be construed.
It is well documented that open reading frames containing high GC content show poor expression in A+T rich hosts. Specifically, G+C-rich codon usage is a limiting factor in heterologous expression of ...Mycobacterium avium subsp. paratuberculosis (MAP) proteins using Lactobacillus salivarius. However, re-engineering opening reading frames through synonymous substitutions can offset codon bias and greatly enhance MAP protein production in this host. In this report, we demonstrate that codon-usage manipulation of MAP2121c can enhance the heterologous expression of the major membrane protein (MMP), analogous to the form in which it is produced natively by MAP bacilli. When heterologously over-expressed, antigenic determinants were preserved in synthetic MMP proteins as shown by monoclonal antibody mediated ELISA. Moreover, MMP is a membrane protein in MAP, which is also targeted to the cellular surface of recombinant L. salivarius at levels comparable to MAP. Additionally, we previously engineered MAP3733c (encoding MptD) and show herein that MptD displays the tendency to associate with the cytoplasmic membrane boundary under confocal microscopy and the intracellularly accumulated protein selectively adheres to the MptD-specific bacteriophage fMptD. This work demonstrates there is potential for L. salivarius as a viable antigen delivery vehicle for MAP, which may provide an effective mucosal vaccine against Johne's disease.
Survival of Staphylococcus epidermidis (10(2) organisms/ml) in solutions containing various levels of radioactivity was assessed. Six test preparations contained nonbacteriostatic 0.9% sodium ...chloride solution; four of these contained technetium Tc 99m pertechnetate (99mTcO-4) in various quantities (80, 250, 500, and 750 mCi). A fifth contained technetium that had decayed to an essentially nonradioactive form, and a sixth contained 0.9% sodium chloride solution only. Each of the six 20-ml solutions was inoculated with 2 ml of single-strength trypticase soy broth (TSB) containing 10(3) organisms/ml. At various times up to 12 hours after inoculation, 1-ml aliquots of each test solution were withdrawn and passed through 0.22-micron filters, thereby preventing further irradiation of the filtered organisms. The filters were incubated in single-strength TSB at 37 degrees C, and samples were examined for turbidity at 24, 48, and 72 hours. After 24 hours, 25 of the 36 sample tubes showed turbidity; after 48 hours, the turbid samples totaled 28. Bacteria in the two nonradioactive solutions remained viable throughout the 12-hour sampling period. Accumulated doses of radiation obtained in the 250-, 500-, and 750-mCi samples inhibited bacterial growth. To be a valid quality-control measure, sterility monitoring of prepared radiopharmaceutical dosage forms may need to be performed concurrently with their preparation.
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