Case presentation of the smallest non-functional parathyroid carcinoma and review of the literature.

INTRODUCTION: Non functional parathyroid carcinoma (PC) is one of the rarest malignant neoplasms. Due to the lack of symptoms and laboratory findings, it is mostly diagnosed in late AQ2 stages, when local invasion and dissemination are already present. However, our case is an exception, because it was detected in early stage, with no local invasion present. We present a case of the smallest non-functional PC yet reported and review of the literature. CASE PRESENTATION: A 47-year-old woman was admitted to outpatient Clinic where fine-needle aspiration biopsy (FNAB) of bilateral thyroid nodules (slide 1) and central neck mass (slide 2), which was suspected to be an enlarged lymphatic nodule or parathyroid gland was performed. Results came back as Bethesda I-colloid (slide 1), and Bethesda IV (slide 2), stating that it is hard to distinguish thyroid gland oxyphil lesions from parathyroid cells. Total thyroidectomy was performed as well as excision of the left central neck mass, without any involvement of surrounding structures. Pathological examination revealed bilateral thyroid follicular nodular disease, papillary microcarcinoma, and parathyroid carcinoma with vascular and capsular invasion, measuring 10 × 8 × 7 mm. The immunohistochemical profile included positive PTH, Chromogranin A, and negative TTF1. CONCLUSION: Non-functional PC is usually diagnosed in advanced stages, already involving adjacent structures; however, this case presents a rare example. It is important not to exclude PC as a differential diagnosis in the absence of elevated Ca and PTH serum levels. Follow-up will be difficult, since there are no prognostic parameters to rely on.

Active to sterile neutrino mixing limits from neutral-current interactions in MINOS.

Results are reported from a search for active to sterile neutrino oscillations in the MINOS long-baseline experiment, based on the observation of neutral-current neutrino interactions, from an exposure to the NuMI neutrino beam of 7.07×10(20) protons on target. A total of 802 neutral-current event candidates is observed in the Far Detector, compared to an expected number of 754 ± 28(stat) ± 37(syst) for oscillations among three active flavors. The fraction f(s) of disappearing ν(µ) that may transition to ν(s) is found to be less than 22% at the 90% C.L.

First direct observation of muon antineutrino disappearance.

This Letter reports the first direct observation of muon antineutrino disappearance. The MINOS experiment has taken data with an accelerator beam optimized for ν(µ) production, accumulating an exposure of 1.71 × 10²° protons on target. In the Far Detector, 97 charged current ν(µ) events are observed. The no-oscillation hypothesis predicts 156 events and is excluded at 6.3σ. The best fit to oscillation yields |Δm²| = [3.36(-0.40)(+0.46)(stat) ± 0.06(syst)] × 10⁻³ eV², sin²(2θ) = 0.86(-0.12)(+0.11)(stat) ± 0.01(syst). The MINOS ν(µ) and ν(µ) measurements are consistent at the 2.0% confidence level, assuming identical underlying oscillation parameters.

Measurement of the neutrino mass splitting and flavor mixing by MINOS.

Measurements of neutrino oscillations using the disappearance of muon neutrinos from the Fermilab NuMI neutrino beam as observed by the two MINOS detectors are reported. New analysis methods have been applied to an enlarged data sample from an exposure of 7.25×10(20) protons on target. A fit to neutrino oscillations yields values of |Δm(2)|=(2.32(-0.08)(+0.12))×10(-3) eV(2) for the atmospheric mass splitting and sin(2)(2θ)>0.90 (90% C.L.) for the mixing angle. Pure neutrino decay and quantum decoherence hypotheses are excluded at 7 and 9 standard deviations, respectively.

Search for Lorentz invariance and CPT violation with the MINOS far detector.

We searched for a sidereal modulation in the MINOS far detector neutrino rate. Such a signal would be a consequence of Lorentz and CPT violation as described by the standard-model extension framework. It also would be the first detection of a perturbative effect to conventional neutrino mass oscillations. We found no evidence for this sidereal signature, and the upper limits placed on the magnitudes of the Lorentz and CPT violating coefficients describing the theory are an improvement by factors of 20-510 over the current best limits found by using the MINOS near detector.

Suprascapular nerve rotator cuff compression syndrome in volleyball players.

Selective denervation of the infraspinatus muscle producing weakness and wasting has been reported in certain sports (eg, volleyball and baseball). Nerve kinking or friction caused by excessive infraspinatus motion and compression by superior or inferior transverse scapular ligament or ganglions have been proposed as possible causes. However, in extreme abduction with full external rotation of the shoulder, the medial tendinous margin between the infraspinatus and supraspinatus muscles impinges strongly against the lateral edge of scapular spine, compressing the intervening infraspinatus branch of the suprascapular nerve. Spinaglenoid notchplasty has been performed in 5 elite volleyball players with infraspinatus neuropathy, allowing recovery of shoulder function in all patients and correction of infraspinatus muscle wasting. All returned to the same or higher level of volleyball by 8 months after surgery. An alternative cause of infraspinatus compromise in volleyball players is proposed and has been treated surgically with satisfactory outcome.

Prognostic parameters for survival of patients with malignant mesenchymal tumors of the uterus.

BACKGROUND: Malignant mesenchymal uterine neoplasms are the most aggressive type of primary uterine tumors, with most patients dying within a few years of diagnosis. Thus, it would be very important to define prognostic factors for predicting the malignancy potential of at least some of their subtypes. METHODS: Flow cytometric cell cycle analysis (proliferative activity, DNA ploidy, and DNA index) was performed on archival paraffin embedded blocks from 80 patients with malignant mesenchymal uterine neoplasms (endometrial stromal sarcomas, malignant smooth muscle tumors, and malignant Müllerian mixed tumors). The Cox proportional hazards regression model was used to assess relative effects of the following factors on patient survival: clinical stage, mode of therapy, DNA+proliferative activity, DNA index, histologic type, cellularity, degree of atypia, mitotic activity, and depth of myometrial invasion. RESULTS: There were 9 low grade stromal sarcomas, 17 high grade stromal sarcomas, 8 smooth muscle neoplasms with uncertain malignant potential, 23 leiomyosarcomas, and 16 homologous and 7 heterologous malignant Müllerian mixed tumors. In univariate analysis for stromal sarcomas, statistical significance was found for DNA ploidy+proliferative activity (P < 0.001), histologic type (P = 0.005), and DNA index (P < 0.001). In multivariate analysis, DNA index appeared to be the only significant parameter influencing patient survival (P = 0.005). In univariate analysis for malignant smooth muscle neoplasms, statistical significance was detected for mitotic activity (P = 0.049) and International Federation of Gynecology and Obstetrics classification (P = 0.021), but in multivariate analysis, clinical stage appeared to be the only significant parameter influencing patient survival (P = 0.032). In univariate analysis for malignant Müllerian mixed tumors, statistical significance was found for the depth of myometrial invasion (P = 0.039), DNA index (P = 0.037), and clinical stage (P = 0.013), but in multivariate analysis, only the depth of myometrial invasion (P = 0.036) and clinical stage (P = 0.025) were of statistical significance. CONCLUSIONS: The most powerful prognostic indicator for stromal sarcomas was the DNA index, for malignant smooth muscle neoplasms it was the clinical stage, and for malignant Müllerian mixed tumors it was the depth of myometrial invasion.

[Extracorporeal respiratory assistance. Experience in the treatment of severe acute respiratory failure]. / Apoyo respiratorio extracorpóreo: experiencia en el tratamiento de la insuficiencia respiratoria aguda severa.

Acute respiratory distress syndrome (ARDS) secondary to systemic injury has a high mortality. Symptomatic treatment with mechanical ventilation, PEEP and high levels of inspired oxygen is effective for most of the patients. When ventilatory support fails in reversing hypoxemia, extracorporeal respiratory assistance has been advocated as a temporary treatment until lung repair occurs. We described our experience in eleven patients (9M, 2F, 41 +/- 16 yo) with severe ARDS refractory to conventional treatment and expected to die if not assisted with extracorporeal oxygenation. All patients required invasive monitoring; seven needed continuous renal therapy because of concurrent renal failure. Venous-venous percutaneous cannulation and systemic anticoagulation were performed and extracorporeal oxygenation and CO2 removal started with blood pump flows of 20 to 30% of patient cardiac output. Improved oxygenation and decreased CO2 levels were immediately observed in 10/11 patients. One patient failed to have reversal of hypoxemia because recirculation and died shortly after initiation of extracorporeal therapy. Plasma leak syndrome and bleeding were observed in 3 and 2 patients respectively. Extracorporeal assistance was maintained for 52 +/- 34 h (19-134). Five (45%) patients were weaned off the pump and two (18%) survived and were discharged. Despite the high cost, extracorporeal respiratory assistance, when applied to selected patients, can reverse hypoxia and may save some previously unsalvagable patients, allowing them to return to a normal life.

Prognostic value of steroid hormone receptors concentration in patients with endometrial carcinoma.

The concentrations of progesterone receptors in endometrial tumors of 160 patients were analyzed with respect to survival and presence of clinicopathologic prognostic factors. The concentration of 25 fmol/mg of proteins for progesterone receptors appeared to be most powerful for prediction of survival. The survival was also significantly correlated to age, depth of myometrial invasion and clinical stage of the tumor. Concentration of estrogen receptors could not be correlated with the probability of patients' actuarial survival.

[Clear cell carcinoma of the female genital tract]. / Klarocelularni karcinom zenskog spolnog sustava.

From 1980 to 1989 clear-cell carcinoma was diagnosed in 66(4.2%) out of 1562 adenocarcinomas of the female genital tract: in the ovary, 2.9% in the endometrium, 9.8% in the uterine cervix; 4.5% in the vagina, and 1.9% in the Fallopian tube. The diagnosis was made at clinical stage I in 26.9% of cases located in the ovary, 62.5% in the endometrium, and 42.8% in the uterine cervix. At stages III and IV the highest percentage of cases was diagnosed in the ovary -42.3% and 26.9%, respectively. The material was divided into the histological subtypes, and the glandular papillary was found in 54.5%, the tubulocystic in 31.8% and the solid in 13.6% of cases. The tubulocystic subtype showed the best prognosis, with the 50% five-year survival rate, while the glandular papillary subtype had 38.1%, and the solid subtype a 14.3 five-year survival rate was 66.6% for the ovary, 85% for the endometrium and 75% for the uterine cervix. For all other stages together (II, III, IV), the five-year survival rate was 0% for the ovary, 20% for the endometrium and 0% for the uterine cervix.

[Histologic type and tumor maturity as prognostic factors in malignant epithelial tumors of the ovary]. / Histoloski tip i zrelost tumora kao prognosticki faktor kod malignih epitelnih tumora jajnika.

A retrospective pathological analysis of 664 patients with malignant ovarian epithelial tumors of coelom epithelium origin was performed. In 93 cases (14%) proliferative tumors were found. Out of the remaining 571 cases a group of 311 cases with the five-year survival in the period 1965-1980 was singled out (39.9% invasive and 98% proliferative tumors). The clinical staging of the illness is the most important prognostic factor. In the clinical stage I the five-years survival was 78.8%, the difference being statistically not significant in relation to the histological maturity of the tumors. For any further clinical stage the five-year rate of survival decreased by about 30%. In the clinical stages II, III and IV survival statistically significantly differed (p less than 0.01) with regard to the histological grade of maturity I, whereas the survival was almost the same in cases with moderately or poorly differentiated tumors. Regardless of the clinical stage of the illness, the five-year survival rate for histological grade I was 71.8%, for grade II 24.5% and for grade III 20.4%. According to the histological type of the tumors, the best prognosis is for mucinous cancers, where the five-year rate of survival was 51.4%, and the worst for undifferentiated (13.3%) and clear-cell cancers (16.7%).

[The physiopathology of retinal circulation: consequences of acute retinal vascular occlusion]. / Physiopathologie de la circulation rétinienne: consequences d'une occlusion vasculaire rétinienne aiguë.

A constant oxygen supply from the retinal and choroidal vascular system is essential for the maintenance of the retinal electrical activity. Arterial or venous retinal obstruction modifies the hemodynamics in the retinal circulation and produces hypoxia in the affected area. In the case of arterial obstruction, severe hypoxia (anoxia) rapidly (in less than 45 min) produces irreversible cell damage in the inner area of the retina. With venous obstruction, the hypoxia is moderate and the retinal damage is partial. In some cases, hypoxia regresses because the formation of collateral vessels most probably provides adequate perfusion. In cases of irreversible venous obstruction, insufficient formation of collateral vessels results in the development of ischemic regions in the retina and severe hypoxia. In these cases preretinal neovascularization may develop.

[Experimental venous thrombosis: preretinal PO2 before and after photocoagulation]. / Thrombose veineuse expérimentale: PO2 prérétinienne avant et après photocoagulation.

Experimental occlusion of a retinal vein leads to retinopathy in the affected drainage area. In some cases the formation of ischemic regions, where the retina is completely destroyed, is typical for the development of this retinopathy. Laser photocoagulation restores the physiological preretinal oxygen pressure in these hypoxic regions. It is possible that the rise in O2 pressure which has been observed is caused by destruction of pigment epithelium and the photoreceptor layer, as oxygen diffuses freely from the choroid to the inner retina without being consumed by the outer layers.

[Comparison of the anti-inflammatory effect of collyria of dexamethasone and diclofenac]. / Comparaison de l'effet anti-inflammatoire des collyres de dexamethasone et de diclofenac.

A clinical double-blind study of patients who had undergone intracapsular cataract extraction with intraocular implant was performed in an attempt to compare the anti-inflammatory effect of Dexamethasone and Diclofenac eye drops. The parameters compared were: degree of inflammation of the anterior chamber; pachymetry of the cornea; objective and subjective tolerance of the eye drops; examination of the fundus (fluorescein angiography on the 60th day); intraocular pressure. The statistical analysis of the different parameters shows a tendency in favor of the non-steroidal agent for intraocular pressure; there was no apparent difference in the anti-inflammatory actions of the two substances.

Determinacion en sangre arterial de las presiones parciales de 02 y del pH en muestras seleccionadas de la poblacion del mineral El Salvador, Chile (2.416 m. de altitud). / Arterial blood determinations of pH and partial pressures of oxygen and carbon dioxide in samples selected from inhabitants of the El Salvador mine (2,416 meters)

Se muestran los valores de los gases en sangre arterial, hematocrito y hemoglobina en 55 sujetos sanos, residentes en un campamento cuprifero a una altitud de 2.416 m. sobre el nivel del mar. Estos muestran una alcalosis respiratoria compensada con una menor reabsorcion de bicarbonato por el rinon, respecto de los sujetos que residen a nivel del mar. Se reproducen, por lo tanto, cambios similares a los observados en grandes alturas aunque de menor intensidad en los mecanismos reguladores de la ventilacion, acido base, hematocrito y hemoglobina. Los cambios en los mecanismos reguladores de la ventilacion se establecerian en un punto de equilibrio en un lapso superior a una semana

Availability of schedule 3 preparations from community pharmacies.

A survey was conducted to determine the ease with which commonly misused schedule 3 (S3) preparations could be purchased from 29 randomly selected pharmacies. The proprietary formulations chosen for study were Phensedyl linctus, Avil tablets and Ponderax tablets. The regulations governing the sale of S3 preparations in South Australia state that they must be sold under the direct supervision of a registered pharmacist, but, in the majority of cases, this did not occur. In a follow-up study where pharmacists were questioned on their knowledge of the regulations, all indicated that they were aware of the details of the regulations and complied with them.