Efficacy of lenalidomide in association with cyclophosphamide and dexamethasone in multiple myeloma patient with bilateral retro-orbital localisation.

Extramedullary localisation is an uncommon manifestation in multiple myeloma (MM). Ocular involvement is rare. Here, we describe a relapse of MM with bilateral retro-orbital localisation without any bone involvement with good and rapid response to therapy with lenalidomide, dexamethasone, and cyclophosphamide.

The importance of intra-operative imaging during cochlear implant surgery.

Two unusual cases of cochlear implant (CI) surgery complication are reported: introduction of the electrode array into the superior semicircular canal with normal morphology and a growing amplitude of neural potential (neural response imaging, NRI) during intra-operative monitoring control. In the first case, a two-year-old patient affected by congenital sensorineural profound deafness was bilaterally implanted with two Clarion 90 k devices and intra-operative electrophysiological and radiological controls were performed. After introduction of the array in the right side NRI was performed and a neural potential was found only on two apical electrodes. Radiological intra-operative control with antero-posterior trans-orbital plain films was performed to assess the position of the electrodes inside the cochlea. Radiography showed the electrode array in the superior semicircular canal in the right ear. The electrode array was removed and reinserted correctly. In the second case, a 72-year-old man underwent left cochlear implantation for sensorineural profound deafness of unknown origin. Intra-operative electrophysiological testing (NRI) showed the presence of neural potential on three tested channels. In this case, as routinely employed since 2006, an intra-operative static fluoroscopy control was performed, this showed the electrode array in the superior semicircular canal. The electrode array was removed and reinserted correctly. In conclusion, intra-operative monitoring tests during CI surgery play different roles: measurement of impedances and NRI can evaluate the integrity of implant electrodes and the status of the electrode cochlea interface, but they cannot be the only way to confirm correct positioning of the array. In our opinion the intra-operative radiological check is helpful during CI surgery, especially when there is any doubt about correct electrode insertion.

Air-collection behind the ear: a rare complication in cochlear implant surgery.

A rare case of cochlear implant surgery complication is described: air collection behind the ear. A 61-year-old male with a 20-year history of progressive bilateral profound sensorineural hearing loss underwent cochlear implant surgery on the left ear with Clarion Hi-Res 90K (Advanced Bionics, Sylmar, CA, USA). Ten days after surgery, the patient presented visible tumefaction behind the ear corresponding to the receiver-stimulator. Ultrasonography, with a probe of 30 MHz, of the surface behind the ear showed formation of probable liquid content but aspiration with a 20-gauge needle yielded 30 cm3 of air without blood or pus. An unusual case is described of a minor complication occurring in an adult cochlear implant patient presenting a swelling behind the ear that was found to be collected air. Although ultrasonography can be useful to evaluate localization of swelling behind the ear and to differentiate between liquid and solid collection, it is not useful for identification of air collection. The Eustachian tube test can show an abnormally patent tube and prevent this complication.

Surveillance for West Nile virus cases in Louisiana 2001-2004.

West Nile virus (WNV) was first detected in Louisiana during August of 2001. An outbreak of 204 human cases of neuro-invasive disease (NID) and 25 deaths occurred in 2002. In the 2 years following, lower numbers of human cases were identified (101 NID cases in 2003 and 84 in 2004) but intense localized foci were observed. The incidence of NID has been particularly high in the elderly (65 years and older). The distribution of West Nile cases has consisted of sporadic cases with a few very intense foci. Annually, human cases have occurred from June through December, with a peak number of new cases in August. As compared with other WNV serosurveys conducted in the United States, it appears that the WNV seroprevalence in Louisiana is not elevated.

The otoliths of the antarctic teleost Trematomus bernacchii: scanning electron microscopy and X-ray diffraction studies.

The authors studied the otoliths of the Nototheniid Trematomus bernacchii with scanning electron microscopy and X-ray diffraction analysis. Results obtained reveal that three otoliths are present: a large sagitta, a lapillus and a fragile asteriscus. Their sensorial faces appear finely decorated as shown by scanning electron microscopy (SEM). The sagitta and the lapillus are aragonitic while the asteriscus is vateritic, as demonstrated by X-ray diffraction.

Apoptosis during chick inner ear development: some observations by TEM and TUNEL techniques.

In order to clarify the occurrence, distribution and possible role of apoptosis during inner ear development, the ultrastructural aspects (by TEM) (at 9-19 incubation day and 1 day after hatching) and the distribution of the apoptotic phenomenon (by the TdT-mediated dUTP nick end-labeling technique), were studied in the crista ampullaris of chick embryo at 5-19 days of incubation to hatching and of postnatal 1-day old chick. We found, in the sensorial epithelium, dark supporting cells in chick embryos and mainly dark hair cells in postnatal chicks, both with ultrastructural features consistent with those of apoptosis. The presence of apoptotic phenomena was confirmed by the TUNEL technique. According to our findings, it is hypothesized that apoptosis in the inner ear may be involved: 1) at first, in macroscopic remodelling of the membranous labyrinth in early developmental stages, 2) later, in the correct differentiation of the hair and of the supporting cells, leading to characteristic cellular pattern formation and 3) finally, in physiological cell turnover of the postnatal chicken sensorial epithelium of the crista.

Calcification processes in the chick otoconia and calcium binding proteins: patterns of tetracycline incorporation and calbindin-D28K distribution.

In order to clarify the otoconia formation and turnover, tetracycline, an antibiotic that precipitates at calcifying fronts and serves as a fluorescent marker, was injected into eggs at different stages of chick embryonic development, as well as into postnatal chicken and into adult animals. The changes in the intensity, location patterns and time course of fluorescent labelling in each examined stage in the otolithic organs was studied. The presence and distribution of calbindin (CB)-D28K, one of the calcium-binding proteins constantly found in the mammalian and chicken cochlea and also in otolithic membrane of some adult mammals, was studied. Results in embryonal stages, postnatal and adult animals allow us to postulate that otoliths are mainly produced during the embryonal phase, but they may also be produced throughout the whole life span. Results also indicate that otoconia are dynamic structures which undergo turnover. The correspondence between the patterns of CB-D28K immunoreactivity and tetracycline fluorescence may indicate that CB-D28K participates in the formation of otoconia.

Role of planimetric analysis in diagnosing thyroid follicular lesions on fine needle aspiration biopsies: a study with histologic correlation.

BACKGROUND: Follicular lesions represent a gray area of interpretation in fine needle aspiration biopsy (FNAB) of the thyroid, with as much as 25% inconclusive reports. We identified "predominantly follicular lesions" (PFLs) as the cytologic category most apt to take advantage of planimetric analysis to reach a more definitive diagnosis. STUDY DESIGN: Sixty-eight cases of FNAB were diagnosed as PFL among the 1,296 FNABs submitted to our institution between January 1994 and June 1995. These cases underwent planimetric analysis with a Leica semiautomatic image analyzer. A smear from a colloid nodule was used as a reference slide. Nuclear areas, perimeters, form factors and maximum diameters were evaluated. Cases in which nuclear areas and maximum nuclear diameters values were found to be > or = 30% higher than the corresponding values found in the reference slide were reported to the clinician as suspicious for malignancy ("flagged" by the computer). These cases required closer follow-up with repeat FNAB within a month, ultrasound and nuclear imaging studies. Nineteen of these cases underwent surgical resection. RESULTS: Histologic reports diagnosed 9 cases of follicular carcinomas, 4 cases of follicular adenomas and 6 cases of nodular hyperplasia. When nuclear areas, perimeters and maximum diameters were all utilized, all the malignant lesions were reported correctly by the computer analysis as flagged, and all the benign lesions were reported as "not flagged." The sensitivity and specificity were 100%, and statistically significant correlations were proven. CONCLUSION: Although the above data provide strong evidence for the value of planimetric analysis in differentiating between follicular lesions, we cannot reach definitive conclusions on the basis of such a limited number of cases. However, the results stimulated our current efforts in applying planimetry along with the evaluation of other biologic markers to a larger set of cases.

Management of cervical intraepithelial neoplasia of the uterine cervix: 110 cases treated by cold-knife conization.

PURPOSE OF INVESTIGATION: The purpose of this study was to evaluate treatment by cold-knife-conization in women carriers of cervical intraepithelial neoplasia (CIN). METHODS: The histologic findings of pre-clinical neoplasia of the cervix after conization were compared to the previous findings of cytology, colposcopy and punch-biopsy in 110 women examined between 1985 and 1995. The chi square test (chi2) was used for the statistical analysis. RESULTS AND CONCLUSIONS: A close correlation is clinically important where complementary roles of these three methods are used to identify lesions suitable for local ablative therapy. The Pap test alone is no longer sufficient for the screening of the pre-cancerous lesion of the cervix and colposcopy is compulsory each time the smear is inadequate or altered. Conization permitted us to single out 13 (11.8%) cases of carcinoma. After cold-knife conization we had six (5.4%) recurrences within two years and two (1.8%) within three years. Our data show that conservative therapy by conization in women with CIN reduces the risk of invasive cancer of the cervix but careful follow-up of these patients is essential.

Cytology, histology, and colposcopy in the diagnosis of neoplastic non-invasive epithelial lesions of the cervix.

The purpose of our study was to examine the concordance among colposcopy, cytology, and histology in the diagnoses of intraepithelial lesions of the uterine cervix. We compared the results of Pap tests, biopsies, and colposcopy in 190 patients, who had histologically proven CIN and/or HPV infection, using histology as "the gold standard". The chi 2 (chi square) test was used for the statistics analysis. The sensitivity of cytology for the detection of CIN was 70%, and was lower for LGL (low grade lesions) than for HGL (high grade lesions): 61.2% versus 88.5%, respectively (p < 0.0001). We obtained a high rate of false negative smears (30%), with a relatively high rate of inadequate samples (59.6%). The sensitivity of colposcopy was 92%. Our results suggest that the Pap test alone is no longer sufficient for the screening of precancerous lesions of the cervix, and colposcopy is compulsory each time the smear is inadequate or altered.

Chitosan-mediated stimulation of macrophage function.

According to the modern definition of biocompatibility, a biocompatible material need not be inert but be bioactive. A benign reactivity implies that the reactivity has to be appropriate for the intended use. Chitosan, a non-acetylated or partially deacetylated chitin (a linear homopolymer of beta (1-4)-linked N-acetylglucosamine) has been proposed as a biomaterial because of its apparent satisfactory biocompatibility. The present investigation demonstrates that chitosan has an in vitro stimulatory effect on both macrophage nitric oxide (NO) production and chemotaxis. The macrophage NO secretion is attributed to the N-acetylglucosamine unit of the chitosan molecule rather than to the glucosamine residue (28 and 15 microM NO respectively). Moreover, the immune stimulatory effect of chitosan was very specific since other glycosaminoglycans, such as N-acetyl-D-mannosamine and N-acetyl-D-galactosamine, had no effects on NO production (5 and 8 respectively). In vivo experiments strengthen this hypothesis. Transmission electron microscopy analysis identifies the presence of many leucocytes in the specimens after 14 d post-implantation, showing poor healing processes (i.e. fibroblast proliferation and collagen deposition) that characterize the tissue repair at this time in our animal model.

Immunocytochemistry of carbonic anhydrase and non-radioactive detection of its RNA by in situ hydridization in the chick embryo membranous labyrinth.

An immunocytochemical study was carried out with the aim to localize carbonic anhydrase isozymes (CA I and CA II) in the chick membranous labyrinth. CA I and CA II were localized in the same cells and, during the early developmental stages, were diffusely present in the labyrinthine epithelium. At later stages, the sensorial epithelium of the maculae acusticae, crista ampullaris and papilla basilaris, as well as labyrinthine dark cells and the epithelium of the endolymphatic sac strongly stained by the immunocytochemical procedure. In 1-day and 1-week old chicks, CA was present in the same sites as at advanced embryonal stages. In order to detect mRNA for carbonic anhydrase II, in situ hybridization was also used. Strong hybridization signals were observed in the sensorial epithelium of the saccule, utricle and crista ampullaris, in the tegmentum vasculosum, the endolymphatic sac, the erythrocytes and the choroid plexus in embryos older than 10 days. This positivity persisted until the day after hatching. The authors discuss the significance of labyrinthine CA and, based on in situ hybridization results, suggest that melanocytes do not provide labyrinthine dark cells with enzyme protein.

Primary carcinoma of the vagina. Case report.

An unusual case of Primary Carcinoma of the vagina was recently observed. The patient was treated surgically in 1981 for squamous cervical carcinoma in situ (CIN 3); eight years later the same patient was treated for squamous carcinoma of the vagina that involved the upper, median and lower tract. She was treated with radical colpectomy and VBP chemotherapy for three courses. The pathology, natural history and treatment are discussed.

Diskospondylitis in a kennel of dogs: clinicopathologic findings.

Selected aspects pertaining to the cause and pathogenesis of diskospondylitis were investigated in a kennel of 45 Airedale Terriers. Diskospondylitis was detected via spinal radiography in 17 male and 14 female dogs. Bacteria isolated from the coat, vagina, and urine of affected Airedales were not statistically different from those isolated from clinically normal Airedales. Serologic evidence of Brucella canis infection was not detected. There was no difference in response to thyrotropin stimulation tests between affected and clinically normal dogs. Necropsy findings in affected dogs included hypercellular renal glomeruli and pulmonary arterial thrombi.

Calcite in the statoconia of amphibians: a detailed analysis in the frog Rana esculenta.

The otoconia of Amphibia, especially of the frog Rana esculenta, were studied by X-ray diffraction and scanning electron microscopy (SEM). The SEM studies showed that the membranous labyrinth of Amphibia contains two populations of crystals, which can easily be distinguished by their forms. The X-ray diffraction data indicated that these two populations consist of calcite and aragonite; the endolymphatic sac, the saccule and the lagena contain aragonite, whereas calcite is only found in the otolithic membrane of the utricle. The genetic and functional significance of the existence of two crystalline forms of calcium carbonate in the membranous labyrinth are discussed.

Scanning electron microscopic and x-ray diffraction studies of otoconia in the lizard Podarcis s. sicula.

The otoliths of embryos and young animals of the lizard Podarcis s. sicula were studied by X-ray diffraction and scanning electron microscopy. Two types of crystal that give different X-ray diffraction patterns were found in the membranous labyrinth of Podarcis. The crystals consist of calcite or aragonite and are easily distinguished by scanning electron microscopy because of their different morphology. The two calcium carbonate crystal forms are not mixed at random but are present in the embryo from the very beginning in specific sites. The endolymphatic sac contains aragonite crystals while the saccule contains calcite crystals adjacent to the wall, in addition to a preponderance of aragonite crystals. The utricle and lagena contain only calcite crystals. The presence of two crystal forms of calcium carbonate in the membranous labyrinth are discussed in terms of differing genetic and functional significance.