MUC2 expression in primary mucinous and nonmucinous adenocarcinoma of the prostate: an analysis of 50 cases on radical prostatectomy.

The expression of mucin (MUC2) in prostate cancer has not been well studied previously and may be of prognostic and pathobiologic significance. It is, however, well known that MUC2 expression in mucinous pancreatic and breast cancer represents an indolent pathway since these tumors have a significantly better outcome than their conventional counterparts. Twenty-five cases each of Gleason pattern 3 and 4 mucinous adenocarcinoma of the prostate defined by greater than 25% mucinous component and nonmucinous adenocarcinoma of the prostate were obtained from the surgical pathology files of the Johns Hopkins Hospital and Emory University Hospital. Immunohistochemical stains were performed for MUC2 on all 50 cases. Mean patient age was 60 years (range 44-72 years). MUC2 was expressed in all 25 cases (100%) of mucinous adenocarcinoma of the prostate, irrespective of the Gleason pattern. The nonmucinous component of these cases was negative for MUC2. In contrast, MUC2 expression was significantly lower in nonmucinous adenocarcinoma of the prostate, detected in only 6/25 cases as a focal finding, while 19/25 (76%) of nonmucinous adenocarcinoma of the prostate were completely negative for MUC2 (P<0.01). In six cases that showed focal positivity, MUC2 was expressed in areas with Gleason pattern 3 cancer with extensive mucinous fibroplasia (one case) and prominent intraluminal mucin (five cases). Other areas of these tumors were negative for MUC2. Mucinous adenocarcinoma of the prostate shows diffuse expression of MUC2, a known tumor suppressor, which is not present in either normal prostate or the majority of conventional adenocarcinomas of this organ. This indicates that mucinous adenocarcinoma of the prostate is indeed of the 'colloid type' akin to those in other exocrine organs. It is highly conceivable that this de novo expression of MUC2 has a role, not only in the mucinous differentiation of these tumors and their colloid pattern, but also in their relatively indolent behavior that has been recently elucidated.

Endoscopic chemical cautery of piriform sinus tracts: a safe new technique.

Piriform sinus tracts are thought to be of branchial origin and typically present with suppurative thyroiditis or a lateral neck mass. Endoscopic examination with direct visualization of the internal opening usually confirms the diagnosis. Complex external surgery with complete excision of the tract is the current standard of care. We report two cases of piriform sinus tracts which were managed with silver nitrate cautery of the internal opening. Post-operative closure of the opening was confirmed in one patient. This appears to be a safe and effective technique that eliminates the need for surgery and has not been previously reported.

Suppurative thyroiditis in children: a management algorithm.

OBJECTIVE: To elucidate the etiology of suppurative thyroiditis in children and recommend a management algorithm. METHODS: Case series of 5 pediatric patients with a diagnosis of suppurative thyroiditis seen between January 1999 and April 2007. RESULTS: All 5 patients primarily presented with left-sided intrathyroidal abscesses. The number of infections from first presentation to the time of definitive diagnosis ranged from 1 to 5. Three patients underwent incision and drainage of the abscess once, and 2 had the procedure performed 3 times. Barium swallows identified a piriform sinus tract on the left side in 2 of the 5 patients. Telescopic hypopharyngoscopy identified the internal opening in all 5. Three were managed with complete excision of their tracts and 2 with cauterization of the internal opening with silver nitrate. All 5 are currently asymptomatic. CONCLUSIONS: Suppurative thyroiditis is a very rare infection in children. A left-sided intrathyroidal abscess should immediately arouse suspicion of a piriform sinus tract. Barium swallows may identify the etiology in some cases. Definitive diagnosis requires a hypopharyngoscopy, with detailed telescopic examination of the left piriform fossa apex. Endoscopic chemical cautery of the internal opening is a safe and effective technique, with very low morbidity, and has the potential for cure.

Pediatric head and neck trauma from all-terrain vehicle accidents.

OBJECTIVE: To characterize pediatric head and neck trauma from all-terrain vehicles (ATVs) at a single institution. STUDY DESIGN/SETTING: Retrospective case series at a level I pediatric trauma center. RESULTS: Thirty-four patients were admitted: average age was 12 years, with 68% between 12 and 16 years and 32% under 12 years. The patient was the driver in 74% of cases and the passenger in 17% of cases. Driver average age was 12.7 years and passenger average age was 10.5 years. Seventy-six percent of children were not wearing helmets. Average hospital stay was 6 days, with 81% of cases discharged home. Central nervous system injuries were most common, followed by soft tissue injuries. Soft tissue repair was the most frequent procedure, and most maxillofacial fractures required operative intervention. CONCLUSIONS: ATV-related morbidity and mortality in children are significant public health issues amenable to primary prevention by prohibiting passengers on ATVs and requiring helmet use. SIGNIFICANCE: National trends indicate increasing ATV-related injuries in children.

Irradiated homograft cartilage in laryngotracheal reconstruction--a preliminary experience.

OBJECTIVE: To determine the suitability of irradiated homograft cartilage in pediatric laryngotracheal reconstruction (LTR). METHODS: Retrospective case series at a tertiary care children's hospital. Pediatric patients with subglottic stenosis who had LTRs performed using irradiated homograft costal cartilage. Data was collected on postoperative complications, findings at subsequent endoscopic examinations and final outcome. RESULTS: Minor degrees of graft resorption were observed that did not affect eventual decannulation. CONCLUSION: Irradiated homograft costal cartilage can serve as a successful alternative to the traditional autologous costal cartilage in lower grades of laryngotracheal stenosis.

Failed extubation in the neonatal intensive care unit.

OBJECTIVE: To determine the causes of failed extubation in the Neonatal Intensive Care Unit (NICU) and the need for airway intervention. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care children's hospital. PATIENTS: We identified all premature infants (gestational age <37 weeks) admitted to the NICU of a tertiary care children's hospital from January 1998 until December 2006 who underwent direct laryngoscopy and bronchoscopy (DLB) in the operating room (OR) for failed extubation. Data was collected on weight, gestational age, co-morbid conditions, number of failed extubations, findings at DLB and whether or not a tracheostomy was performed. RESULTS: DLBs were performed on 63 patients to evaluate the cause of failed extubation. Group A comprised of 50 patients who underwent tracheostomy. They had an average gestational age of 30.0 weeks, birth weight of 1457g and number of failed extubations 2.68. Group B consisted of 13 patients who did not undergo tracheostomy. They had an average gestational age of 34.5 weeks, birth weight of 2309g and number of failed extubations 1.33. 56.0% of the tracheostomy group and 38.5% of the non-tracheostomy group had chronic lung disease (CLD). At endoscopy, 44% of Group A and 23.1% of Group B had some degree of subglottic stenosis. CONCLUSION: Abnormal laryngotracheal findings are common in neonates who fail extubation. When compared to their counterparts with similar co-morbidities, neonates with CLD, gestational age of 30 weeks or below and low birth weight are twice as likely to have subglottic edema and fail extubation. They are also likely to be candidates for a tracheostomy.

Urothelial carcinoma of the bladder with transmural and direct prostatic stromal invasion: does extent of stromal invasion significantly impact patient outcome?

Urothelial carcinoma of the bladder with prostatic stromal invasion is included in stage pT4a of the new 2010 American Joint Committee on Cancer/Tumor-Node-Metastasis classification. Despite being a strong indicator of poor prognosis, there have been few large studies investigating the impact of extent of prostatic stromal invasion on patient outcome. A search of the surgical pathology and expert consultation files at our institution was made for cystoprostatectomy specimens diagnosed as urothelial carcinoma with prostatic stromal invasion from 2002 to 2009. Cases were further stratified as follows: group 1--focal prostatic stromal invasion and group 2--extensive prostatic stromal invasion. Only patients who had surgery as monotherapy and those with available follow-up information were selected for this study. Thirty-five cases of urothelial carcinoma with prostatic stromal invasion and follow-up information were identified. Mean patient age was 70 years (range, 44-88 years). Of these 35 patients, 15 (43%) had focal prostatic stromal invasion and 20 (57%) had extensive prostatic stromal invasion. Angiolymphatic invasion was identified in 93% of group 1 cases and 79% of group 2 cases. Positive margins were identified in 50% of group 1 cases and 45% of group 2 cases. Incidence of nodal metastasis was 64% for group 1 and 60% for group 2. Four (27%) of 15 cases in group 1 and 6 (30%) of 20 cases in group 2 had various histologic variants identified. In group 1, there were 2 cases of urothelial carcinoma with micropapillary features and urothelial carcinoma with focal squamous differentiation. In group 2, there were 3 cases of urothelial carcinoma with focal squamous differentiation, 2 cases of urothelial carcinoma with focal sarcomatoid differentiation, and 1 case of urothelial carcinoma with focal micropapillary features. One- and 3-year overall survival for group 1 was 53% and 27%, respectively. One- and 3-year overall survival for group 2 was 47% and 12%, respectively. Mean survival was 17.4 and 16.3 months for groups 1 and 2, respectively. Overall survival curves did not show a statistically significant difference between the 2 groups from initial diagnosis (P = .889) and radical cystoprostatectomy (P = .369). Our study suggests that extent of prostatic stromal invasion by urothelial carcinoma of the bladder as an independent factor does not impact overall patient survival. Other well-known prognostic factors including positive margin status, presence of aggressive histologic variants of urothelial carcinoma, angiolymphatic invasion, and distant metastasis likely play more critical roles in predicting outcome in male patients who have urothelial carcinoma with prostatic stromal invasion.

Sinonasal teratocarcinosarcoma of the head and neck: a report of 10 patients treated at a single institution and comparison with reported series.

OBJECTIVES: To present the clinicopathologic features of 10 sinonasal teratocarcinosarcomas managed at a single center. Teratocarcinosarcoma is a rare morphologically heterogeneous and highly malignant neoplasm. Previous reports of these tumors have focused on their differential diagnosis and histogenesis and consisted of individual case reports and consultation based series. DESIGN: Review of patient medical records and microscopic slides of all tumor tissues. The histopathologic features for each tumor and the demographic, clinical, treatment, and follow-up information were recorded for each patient. Also, a comparison with previously reported series was performed. SETTING: The University of Texas M. D. Anderson Cancer Center. PATIENTS: Ten men ranging in age from 35 to 69 years (mean age, 53 years) were included in the study. They all experienced a short course of symptoms, with an average duration of 3.5 months, and 9 presented with nasal obstruction and epistaxis. Nine patients were treated with both surgery and irradiation. RESULTS: Histologically, the tumors showed primitive neuroepithelial elements and various malignant epithelial and mesenchymal components. Six patients had no evidence of disease by the end of follow-up, which ranged from 72 to 372 months. Three patients died of disease, and 1 patient was lost to follow-up. CONCLUSION: Sinonasal teratocarcinosarcoma of the head and neck is a histologically and biologically heterogeneous malignant neoplasm that is best managed with surgery and postoperative radiotherapy.

Postactivation potentiation response in athletic and recreationally trained individuals.

To determine if training status directly impacted the response to postactivation potentiation, athletes in sports requiring explosive strength (ATH; n = 7) were compared to recreationally trained (RT; n = 17) individuals. Over the course of 4 sessions, subjects performed rebound and concentric-only jump squats with 30%, 50%, and 70% 1 RM loads. Jump squats were performed 5 minutes and 18.5 minutes following control or heavy load warm-ups. Heavy load warm-up consisted of 5 sets of 1 repetition at 90% 1 RM back squat. Jump squat performance was assessed with a force platform and position transducer. Heavy load warm-up did not have an effect on the subjects as a single sample. However, when percent potentiation was compared between ATH and RT groups, force and power parameters were significantly greater for ATH (p < 0.05). Postactivation potentiation may be a viable method of acutely enhancing explosive strength performance in athletic but not recreationally trained individuals. Reference Data: Chiu, L.Z.F., A.C. Fry, L.W. Weiss, B.K. Schilling, L.E. Brown, and S.L. Smith. Postactivation potentiation response in athletic and recreationally trained individuals.