Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells: a case report.

BACKGROUND: Undifferentiated carcinomas of the pancreas with osteoclast-like giant cells (UCPOGC) are rare pancreatic neoplasms that account for less than 1% of all pancreatic malignancies. This case report of a 54-year-old male with metastatic UCPOGC adds to the existing literature and further ascertains the clinical and imaging features, treatment options, and prognosis of this rare entity. CASE PRESENTATION: We present the detailed clinical course of a 54-year-old Asian male patient with UCPOGC, with focus on the relevant clinical features and imaging findings that are characteristic of this disease entity. CONCLUSIONS: UCPOGC is an extremely rare pancreatic tumor with a unique histopathology and clinical course. It is often difficult to distinguish UCPOGCs from other pancreatic tumors, such as traditional pancreatic ductal adenocarcinomas (PDAC), on imaging, and it therefore remains a pathological diagnosis. Surgery is generally regarded as the first-line treatment option, and the roles of chemotherapy and radiation are unclear. Due to the exceeding rarity of this tumor, large-scale clinical studies are not feasible. Therefore, it is important to share individual insights and experiences to improve our understanding and care for patients with this devastating disease.

Imaging uterine lipoleiomyomas: A case series and review of the literature.

Background: Lipoleiomyomas are uncommon uterine lesions containing adipose and smooth muscle tissue. They have a variable presentation and are usually found incidentally on imaging or post-hysterectomy tissue analysis. Given their low prevalence, there is a dearth of literature describing imaging characteristics for uterine lipoleiomyomas. In this image-rich case series, we summarize an example of an initial presentation as well as present ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) findings for 36 patients. Case presentation: We present the detailed clinical course of a representative patient evaluated for uterine lipoleiomyoma and describe imaging findings seen in another 35 patients. This includes ultrasound findings from 16 patients, CT findings from 25 patients, and MRI findings from 5 patients. Among the 36 total patients, symptoms at the time of diagnosis were variable but often included abdominal or pelvic pain; however, most patients were asymptomatic, and the lipoleiomyomas were incidentally discovered on imaging. Conclusions: Uterine lipoleiomyomas are rare and benign tumors with variable presentations. Ultrasound, CT, and MRI findings can assist in diagnosis. Findings on ultrasound typically include well-circumscribed hyperechoic and septated lesions with minimal to no internal blood flow. CT shows fat-containing either homogeneous or heterogeneous circumscribed lesions depending on their ratio of fat and smooth muscle tissue. Lastly, on MRI, uterine lipoleiomyomas commonly appear heterogenous with loss of signal on fat-suppressed sequences. These imaging findings are highly specific for lipoleiomyomas, and familiarity with these findings may reduce unnecessary and potentially invasive procedures.

Handwriting Movement Abnormalities in Symptomatic and Premanifest Huntington's Disease.

BACKGROUND: Kinematic measures of handwriting movements are sensitive to mild subclinical motor abnormalities stemming from a wide range of disorders involving the basal ganglia including Huntington's disease (HD). Prior research has not investigated handwriting movements in at-risk individuals in the premanifest stage of HD. OBJECTIVES: The purpose of this study was to examine whether handwriting movement abnormalities are present prior to clinically manifest chorea in HD. METHODS: A total of 38 symptomatic HD, 30 gene-positive premanifest, and 25 healthy control participants completed handwriting tasks consisting of circles, loops, sentences, and spirals with a noninking pen on a digitizing tablet. Multiple measures of pen stroke kinematics and pressure were measured along with the cognitive and motor status of each participant. Burden of pathology and CAG × age product scores were obtained from each participant with HD. RESULTS: Participants with HD exhibited significantly longer and more variable stroke durations, decreased handwriting smoothness, and increased and more variable pen pressures when compared with the healthy controls. We found significant positive associations between stroke duration and both burden of pathology and CAG × age product. Results from a discriminant function analysis revealed a 7-factor model that distinguished premanifest from healthy controls with 85% accuracy. Factors in the model included greater variability in stroke amplitude, velocity and pen pressure, higher levels of pen pressure, longer stroke durations, and lower velocities for combinations of handwritten circles, sentences, and spirals. CONCLUSIONS: These findings support the clinical utility of dynamic measures of handwriting kinematics as a potential early behavioral biomarker in HD.

Salivary levels of total huntingtin are elevated in Huntington's disease patients.

Patients with Huntington's disease (HD), an autosomal-dominant neurodegenerative disease, show substantial variability in age-of-onset, symptom severity and course of illness, warranting the need for biomarkers to anticipate and monitor these features. The HD gene encodes the disease protein huntingtin (Htt), a potentially useful biomarker for this disease. In the current study, we determined whether total Htt protein (normal plus mutant; "tHtt") could be reliably measured in human saliva, a body fluid that is much more accessible compared to cerebral spinal fluid or even blood, and whether salivary levels of tHtt were clinically meaningful. We collected 146 saliva samples from manifest HD patients, early-premanifest individuals, late-premanifest patients, gene-negative family members and normal controls. We found that tHtt protein could be reliably and stably detected in human saliva and that tHtt levels were significantly increased in saliva from HD individuals compared to normal controls. Salivary tHtt showed no gender effects, nor were levels correlated with total protein levels in saliva. Salivary tHtt was significantly positively correlated with age, but not age-of-onset or CAG-repeat length. Importantly, salivary tHtt was significantly correlated with several clinical measures, indicating relevance to disease symptom onset and/or severity. Measurements of salivary tHtt offer significant promise as a relevant, non-invasive disease biomarker for HD, and its use could be implemented into clinical applications.

Benton Judgment of Line Orientation (JoLO) Test: A Brief and Useful Measure for Assessing Visuospatial Abilities in Manifest, but not Premanifest, Huntington's Disease.

BACKGROUND: Visuospatial deficits have been described in Huntington's disease (HD); however, the extent of these deficits remains unclear. The Benton Judgment of Line Orientation (JoLO) Test, commonly used to assess visuospatial ability, requires minimal motor involvement. It has demonstrated sensitivity to visuospatial deficits in Parkinson's disease; however, few studies have examined performance on this test in HD. OBJECTIVE: The objective of the current study was to assess visuospatial ability in premanifest and manifest HD using the JoLO. METHODS: A global cognitive measure, the Mattis Dementia Rating Scale (DRS), was used to stratify manifest HD patients as mild (DRS ≥129) vs. moderate-severe (DRS ≤128). Fifty mild, 42 moderate-severe, and 30 premanifest HD subjects, as well as 35 matched controls, were administered the JoLO. HD Burden of Pathology (BOP) scores were used as a measure of disease severity. RESULTS: Results revealed that the total manifest HD sample (p <  0.001), in addition to the mild (p = 0.028), and moderate-severe (p <  0.001), but not premanifest, HD subjects scored significantly lower on the JoLO compared to normal controls. CONCLUSIONS: Our results suggest that the JoLO is useful for detecting visuospatial deficits across various stages of manifest HD. However, any visuospatial impairment that might be present during the premanifest stage of HD was not detected using the JoLO in the present sample.

Smart textile-based wearable biomedical systems: a transition plan for research to reality.

The field of smart textile-based wearable biomedical systems (ST-WBSs) has of late been generating a lot of interest in the research and business communities since its early beginnings in the mid-nineties. However, the technology is yet to enter the marketplace and realize its original goal of enhancing the quality of life for individuals through enhanced real-time biomedical monitoring. In this paper, we propose a framework for analyzing the transition of ST-WBS from research to reality. We begin with a look at the evolution of the field and describe the major components of an ST-WBS. We then analyze the key issues encompassing the technical, medical, economic, public policy, and business facets from the viewpoints of various stakeholders in the continuum. We conclude with a plan of action for transitioning ST-WBS from "research to reality."

Wearable sensor systems: opportunities and challenges.

Sensors are pervasive - from homes to battlefields, and everywhere in-between. Examples include microwave ovens, mobile phones, automobiles, and medical equipment. They have become such an "integral" part of our daily lives that they are not only pervasive but they are also "invisible" to the end-user. These systems are facilitating information processing anytime, anywhere for anyone. While these types of sensors and networks incorporating such sensors are relatively new in the timeline of civilization, there has been one piece of "sensing" technology that has been there since the dawn of civilization. And that is textiles, which, in today's world are indeed pervasive. Textiles (clothing) were initially used for "protection" from the environment - be it from climatic conditions or from other predators as camouflage and personal privacy. This first dimension of "protection" has been complemented by the second dimension of "aesthetics," exemplified by the success of fashion houses in modern times - from Armani to Versace.

e-Health and quality of life: the role of the Wearable Motherboard.

It is hard to place a price tag either on human life or on the quality of life. Technology is the key to enhancing the quality of life for everyone in the continuum of life from newborns to senior citizens--whether it is the safe delivery and care of undernourished premature babies, or extending the life of a senior citizen through exploratory treatments and procedures. Technology has the potential to rapidly transform healthcare and the practice of medicine by improving the quality and safety of patient care and increasing the efficiency of healthcare providers. Moreover, the healthcare industry must meet the challenge of balancing cost containment with maintenance of desired patient outcomes and this can be accomplished through the adoption of technology. Any technology that can minimize the loss of human life and/or enhance the quality of life has a value that is priceless. An overview of the key challenges facing the practice of medicine today is presented along with the need for technological solutions that can "prevent" problems. The paradigm of "e-Health" is discussed. Then, the development of the Wearable Motherboard as a "platform" for sensors and monitoring devices that can unobtrusively monitor the health and well-being of individuals (directly and/or remotely) is described. This is followed by a discussion of the applications and impact of this technology in the continuum of life--from preventing SIDS to facilitating independent living for senior citizens. Finally, the future advancements in the area of wearable, yet comfortable, systems that can continue the transformation of healthcare and e-Health to i-Health (for interactive health)--all aimed at enhancing the quality of life for humans--are presented.