An Unusual Cause of Abdominal Pain in a Middle-Aged Female: The Nutcracker Syndrome.

A middle-aged female presented with lower abdominal pain associated with nausea and vomiting and was admitted to the acute hospital. She was thoroughly investigated and treated presumably as having a urinary tract infection. However, she was admitted again shortly after discharge with persistent symptoms. A careful evaluation and review were done, and she was diagnosed with nutcracker syndrome based on the clinical assessment, computed tomography (CT), and ultrasound (US) findings.

Primary gallbladder paraganglioma: A case report and review of literature.

INTRODUCTION: Paragangliomas are tumors arising from paraganglia of the autonomic nervous system. They are rare tumors and occurrence inside the gallbladder is exceptionally rare. Biliary paragangliomas are thought to be associated with the parasymphathetic fibers and are therefore non-functioning and benign. There are less than 10 cases reported in literature and majority are found incidentally upon cholecystectomy. There is no specific treatment for these tumors and resection is considered sufficient. CASE PRESENTATION: 63 year old female presented with recurrent bliary colic exacerbated by fatty food. She underwent imaging work up that was consistent with biliary dyskinesia. She underwent uneventful elective laparoscopic cholecystectomy and was doing well post-operatively. Pathology report was significant for chronic cholecystitis, no calculi, and a small focus of paraganglioma. DISCUSSION: Little is known about primary gallbladder paragangliomas. Due to the non-functioning nature of these tumors there are felt to be benign. We know the paraganglia of the gallbladder consists of both parasymphathetic and sympathetic fibers. The sympathetic paragangliomas tend to act similar to pheochromocytomas and thus have malignant potential. CONCLUSION: We presented a case in which a primary gallbladder paraganglioma was identified incidentally in a patient who presented with symptomatic biliary dyskinesia. Due to the rarity of primary gallbladder paraganglioma and limited reported cases, optimal follow up remains unknown.

Competency-Based Education Frameworks Across Canadian Health Professions and Implications for Multisource Feedback.

BACKGROUND: Feedback in health professional clinical training is typically the responsibility of the student's own supervisor. However, assessment in competency-based education may be optimized by drawing upon the judgments of multiple assessors. Specific interprofessional competencies have been deemed appropriate for multisource feedback, but these skills may not be uniformly described and therefore performance expectations may differ across disciplines. METHODS: We conducted a document content analysis of the educational outcomes for seven Canadian health professional training programs. Competency frameworks for dietetics, medicine, nursing, occupational therapy, pharmacy, physiotherapy, and respiratory therapy were located and systematically compared. RESULTS: All professions organized educational outcomes according to core competencies. As anticipated, interprofessional competencies of communicator, collaborator, and professional appeared in almost all frameworks, but with distinctions in described emphasis and scope. Evidence-based practice is not typically identified as an interprofessional competency but is similarly widely represented across the majority of disciplines. CONCLUSION: Our review suggests common understanding of shared competencies should not be taken for granted insofar as how roles are described across disciplines' educational frameworks. Further study to explore how interprofessional competencies are practically interpreted by clinicians and used to judge students training with their team, but who are outside their own health discipline, is warranted.

A gene expression signature associated with metastatic outcome in human leiomyosarcomas.

Metastasis is a major factor associated with poor prognosis in cancer, but little is known of its molecular mechanisms. Although the clinical behavior of soft tissue sarcomas is highly variable, few reliable determinants of outcome have been identified. New markers that predict clinical outcome, in particular the ability of primary tumors to develop metastatic tumors, are urgently needed. Here, we have chosen leiomyosarcoma as a model for examining the relationship between gene expression profile and the development of metastasis in soft tissue sarcomas. Using cDNA microarray, we have identified a gene expression signature associated with metastasis in sarcoma that allowed prediction of the future development of metastases of primary tumors (Kaplan-Meier analysis P = 0.001). Our finding may aid the tailoring of therapy for individual sarcoma patients, where the aggressiveness of treatment is affected by the predicted outcome of disease.

Genome-wide screening for complete genetic loss in prostate cancer by comparative hybridization onto cDNA microarrays.

We demonstrate that comparative genomic hybridization (CGH) onto cDNA microarrays may be used to carry out genome-wide screens for regions of genetic loss, including homozygous (complete) deletions that may represent the possible location of tumour suppressor genes in human cancer. Screening of the prostate cancer cell lines LNCaP, PC3 and DU145 allowed the mapping of specific regions where genome copy number appeared altered and led to the identification of two novel regions of complete loss at 17q21.31 (500 kb spanning STAT3) and at 10q23.1 (50-350 kb spanning SFTPA2) in the PC3 cell line.

Identification of amplified and expressed genes in breast cancer by comparative hybridization onto microarrays of randomly selected cDNA clones.

Microarray analysis using sets of known human genes provides a powerful platform for identifying candidate oncogenes involved in DNA amplification events but suffers from the disadvantage that information can be gained only on genes that have been preselected for inclusion on the array. To address this issue, we have performed comparative genome hybridization (CGH) and expression analyses on microarrays of clones, randomly selected from a cDNA library, prepared from a cancer containing the DNA amplicon under investigation. Application of this approach to the BT474 breast carcinoma cell line, which contains amplicons at 20q13, 17q11-21, and 17q22-23, identified 50 amplified and expressed genes, including genes from these regions previously proposed as candidate oncogenes. When considered together with data from microarray expression profiles and Northern analyses, we were able to propose five genes as new candidate oncogenes where amplification in breast cancer cell lines was consistently associated with higher levels of RNA expression. These included the HB01 histone acetyl transferase gene at 17q22-23 and the TRAP100 gene, which encodes a thyroid hormone receptor-associated protein coactivator, at 17q11-21. The results demonstrate the utility of this microarray-based CGH approach in hunting for candidate oncogenes within DNA amplicons.