The prevalence of neovascularity in rotator cuff tendinopathy: comparing conventional Doppler with superb microvascular imaging.

AIMS: To determine the prevalence of neovascularity in the supraspinatus tendon of patients presenting with clinically painful unilateral rotator cuff tendinopathy (RCT) using conventional colour Doppler ultrasound (CDU), power Doppler ultrasound (PDU), and superb microvascular imaging (SMI). The association between Doppler findings and clinical scores was also assessed. METHODS: The bilateral supraspinatus of consecutive patients presented with unilateral RCT clinically were evaluated with grey-scale ultrasound (tendon thickening, heterogeneous echotexture, and hypoechogenicity), CDU, PDU, and SMI. The prevalence of neovascularity and grey-scale changes on duplex imaging techniques were analysed. The relationship between neovascularity on CDU, PDU, SMI, and pain/disability as determined using a visual analogue scale (VAS) and the Oxford Shoulder Score (OSS) were assessed. RESULTS: Fifty-nine patients (mean age 53 years, 39 women) were recruited. Of the symptomatic supraspinatus tendons, 42.4% (25/59) demonstrated neovascularity on SMI, compared to 6.8% (4/59) on PDU and 5.1% (3/59) on CDU. Of the asymptomatic supraspinatus tendons, 5.1% (3/59) depicted neovascularity on SMI but not on conventional Doppler techniques. SMI showed a significant correlation with the VAS (r2 = 0.560, p<0.001) and OSS (r2 = 0.62, p<0.001). PDU weakly correlated with the VAS and OSS (r2 = 0.312, p=0.016; r2 = 0.260, p=0.047, respectively) while CDU did not show a significant relationship. CONCLUSION: SMI is superior in demonstrating neovascularity and shows better correlation with pain and functional deficit compared to conventional Doppler in patients with painful RCT. SMI also showed vascularity to a lesser degree in the asymptomatic tendon. Further large-scale studies are needed to prove the diagnostic value of SMI in the assessment of RCT.

Febrile neutropenia and its associated hospitalization in breast cancer patients on docetaxel-containing regimen: A retrospective cohort study on duration of prophylactic GCSF administration.

PURPOSE: To compare febrile neutropenia (FN) incidence and hospitalization among breast cancer patients on docetaxel with no granulocyte colony-stimulating factors (GCSF) primary prophylaxis (PP), 4/5-day PP, or 7-day PP. METHODS: We identified 3916 breast cancer patients using docetaxel-cyclophosphamide (TC), doxorubicin-cyclophosphamide then docetaxel (AC-T), fluorouracil-epirubicin-cyclophosphamide then docetaxel (FEC-T), docetaxel-carboplatin-trastuzumab (TJH), or docetaxel-doxorubicin-cyclophosphamide (TAC) from a hospital pharmacy dispensing database in Hong Kong between 2014 and 2016. Patients were offered GCSF within 5 days since administering docetaxel. Outcomes included FN incidence, time to first hospitalization, hospitalization rate, and duration. RESULTS: In TC regimen, FN incidence (with odds ratio, OR) of patients with no PP, 4/5-day PP, and 7-day PP was 21.69%, 7.95% (OR 0.31, p < 0.001), and 5.33% (OR 0.20, p < 0.001), respectively. In TJH regimen, FN incidence of patients with no PP, 4/5-day PP, and 7-day PP was 38.26%, 8.33% (OR 0.15, p < 0.001), and 8.57% (OR 0.15, p < 0.001), respectively. FN incidence of patients on AC-T regimen with no PP and 4/5-day PP was 20.93% and 6.84%, respectively (OR 0.28, p = 0.005); with FEC-T regimen, the incidence was 9.91% and 4.77%, respectively (OR 0.46, p = 0.035). Only 3.27% FN cases were not hospitalized. Mean (±standard deviation, SD) time to first hospitalization was 8.21 ± 2.44 days. Mean (±SD) duration of hospitalization for patients with no PP, 4/5-day PP, and 7-day PP was 4.66 ± 2.60, 4.37 ± 2.85, and 5.12 ± 2.97 days, respectively. CONCLUSION: GCSF prophylaxis in breast cancer patients on docetaxel could reduce FN incidence and hospitalization. 4/5-day PP demonstrated similar efficacy to 7-day PP with superior saving benefits on healthcare expenditure.

The functional outcome of arthroscopic anterior cruciate ligament reconstruction in patients using different graft tension during tibial fixation

Background@# Anterior Cruciate Ligament (ACL) reconstruction is commonly performed to restore knee kinematics and halt the progression of osteoarthritis. A primary variable that could infl uence the outcome of ACL reconstruction is the tension applied to the graft at the time of fi xation. If the tension is too great, an abnormal compressive force could potentially develop across the tibiofemoral joint, hindering knee motion, and subjecting the articular surfaces to increased stress. If the tension in the graft is too low, the graft will not be effective in restoring normal kinematics. The Tegner Lysholm Knee Scale is a functional scoring for patients with ligamentous injuries. It is a patient-reported measure of knee function and is important for comprehensive assessment conditions in both the clinical and research context. Our objective was to compare which tension technique (15 lbs graft tension using a Mitek Tensioner™ vs maximal sustained two-hand technique) would yield better functional outcome at 6 months and 12 months postoperatively using the Tegner Lysholm Knee Scale. @*Methods @#Twenty-nine patients who underwent arthroscopic ACL reconstruction at the University of Santo Tomas Hospital Private Division were randomly divided equally into two groups (group A or group B). During tibial fi xation, group A would receive 15 lbs graft tension using a Mitek Tensioner and group B would receive graft tension using the maximal sustained two-handed pull technique. The patients underwent a standard rehabilitation protocol at an institution of their choice and a Lysholm Scoring Scale and Tegner activity scale were self-administered at 6 months and 12 months after the surgery in order to assess their functional outcome.@*Results @#The results showed that the functional outcome scores of group A were higher than group B. The yielded p-value was 0.10 (6 months), 0.07 (12 months) for group A and 0.27 (6 months), 0.46 (12 months) for group B. The results showed no suffi cient evidence of a signifi cant difference between the effects of arthroscopic ACL reconstruction with 15 lbs weight using a Mitek Tensioner (group A) and graft tension using the maximal sustained two-handed pull technique (group B) in the knee functional outcome of patients at 6 months and 12 months postoperatively@*Conclusion@#The functional outcome scores of patients who underwent ACL reconstruction using different graft tension did not show signifi cant results. Further re-evaluation of patients’ functional outcome score is necessary after 12 months postoperatively. The desired tensioning technique of the ACL surgeon would be at his/her convenience knowing beforehand the pros and cons of each technique.

Manejo de los tratamientos biológicos en pacientes con psoriasis moderada-grave sometidos a intervenciones quirúrgicas en el registro español Biobadaderm / Management of biologic therapy in moderate to severe psoriasis in surgical patients: data from the Spanish Biobadaderm registry

INTRODUCCIÓN Y OBJETIVO: Disponemos de una gran experiencia en el uso de los fármacos biológicos para el tratamiento de los pacientes con psoriasis, sin embargo, existen situaciones concretas, como la cirugía, en las que pueden surgir dudas sobre su manejo. Aunque las guías de tratamiento aconsejan su suspensión programada previamente a los procedimientos de cirugía mayor, no existe evidencia de cuál es la actitud habitual en la práctica clínica y su asociación a complicaciones. Nuestro objetivo fue analizar el manejo actual de esta situación en la práctica clínica habitual. MÉTODOS: A través de un estudio retrospectivo de la base de datos Biobadaderm se analizó el manejo práctico de pacientes con psoriasis en tratamiento biológico que fueron intervenidos mediante algún procedimiento quirúrgico. RESULTADOS: De los 2.113 pacientes incluidos en Biobadaderm, 48 fueron tratados con una intervención quirúrgica, de las que fueron mayoritarias las de tipo cutáneo (31%). El tratamiento biológico se suspendió en el 42% de los casos. No se observaron asociaciones estadísticamente significativas entre la aparición de complicaciones posquirúrgicas y la interrupción del fármaco. Tampoco se detectó asociación entre la interrupción del tratamiento con otras variables como el sexo, la edad, la duración de la enfermedad y la gravedad de la psoriasis. CONCLUSIÓN: No se ha encontrado asociación entre la continuidad del tratamiento biológico y el riesgo de complicaciones posquirúrgicas, aunque el estudio presenta la limitación de tener un tamaño muestral escaso

BACKGROUND AND OBJECTIVE: We now have considerable experience in the use of biologic agents to treat psoriasis, but doubts about management arise in certain clinical settings. Surgery is one of them. Although treatment guidelines advise that biologics be suspended before major surgery, data about actual clinical practices and associated complications are lacking. We aimed to analyze current practice in the clinical management of these cases. METHODS: Retrospective study of cases in the Biobadaderm database. We analyzed the management of biologic therapy in patients with psoriasis who underwent surgical procedures. RESULTS: Forty-eight of the 2113 patients registered in Biobadaderm underwent surgery. Thelargest percentage of procedures (31%) involved skin lesions. Biologic treatment was interrupted in 42% of the cases. No postsurgical complications were significantly related to treatment interruption. Likewise we detected no associations between treatment interruption and other variables, such as sex, age, or duration or severity of psoriasis. CONCLUSION: Continuity of biologic treatment and the risk of postsurgical complications were not associated in this study, although conclusions are limited by the small sample size

Gender-based violence: don’t ask, don’t tell, don’t care

OBJECTIVE: Our goal was to highlight the ongoing disparity, promote discussion, and advocate for further funding to examine the factors associated with sexual violence to target prevention rather than intervention. DESIGN AND METHODS: We compared prevalence, incidence, and economic burden of sexual violence to other major public health issues in the US: cardiovascular disease, cancer, and diabetes. We compared the public funding allocated to an issue as a proxy of the social priority of addressing the issue. Finally, we calculated the ratio of public funding to economic disease burden. RESULTS: [Table]. CONCLUSION: Public funds allocated to sexual violence were a fraction of those allocated to other major public health issues such as cardiovascular disease, cancer, and diabetes despite similar incidence, prevalence, and economic burden between them. While sexual violence was similarly prevalent and costly to these other major public health issues, it received a fraction of public funds.

A cyclometallated iridium(III) complex as a c-myc G-quadruplex stabilizer and down-regulator of c-myc oncogene expression.

A new cyclometallated iridium(III) complex with the 2,2'-biquinoline N-donor ligand has been synthesized and characterized. The interaction and affinity of the complex towards c-myc G-quadruplex and duplex DNA have been investigated using UV/Vis spectroscopy and gel mobility shift assay. These studies revealed that complex 1 binds to c-myc G-quadruplexes (Pu22 and Pu27) with high affinity but does not interact with duplex DNA either by intercalation or groove binding. The ability of 1 to stabilize c-myc G-quadruplex DNA in vitro has also been examined through a PCR stop assay and a cell-based luciferase reporter assay. Complex 1 displays promising cytotoxic activity against the HeLa cell line with sub-micromolar potency.

[Analysis of the relevance and feasibility of quality indicators in nutrition support]. / Análisis de la relevancia y factibilidad de indicadores de calidad en las unidades de nutrición.

INTRODUCTION: The quality assessment in health activities requires the choice of indicators in line with the results we want to measure. Of all possible, we should prioritize those that allow us to obtain the most relevant information without overloading the regular work of our units. OBJECTIVE: To determine the opinion of the members of SENPE regarding the relevance and feasibility of using a selection of quality indicators designed for use in clinical nutrition. METHODS: E-mail survey sent to members of SENPE asking them their views on 12 quality indicators, evaluating each in terms of their relevance and feasibility of implementation in their environment. RESULTS: 40 respondents answered from 40 centers in 12 different regions. In general, the indicators were considered more relevant than feasible. The indicators best rated were: "identification in artificial nutrition bags, "semi-recumbent position in patient with nasogastric tube feeding" and "basic clinical protocols". Considering the type of indicator: "patient identification in the bags of artificial nutrition (structure)," a semi-incorporated "and" basic clinical protocols (process), and "fulfillment of the caloric goal" (result). CONCLUSION: The results of the survey can make a selection of indicators that could be considered for first-line introduction in a Nutrition Unit.

Linfangioma: reporte de un caso y revisión de la literatura / Lymphangioma: a case report and literature review

Los Linfangiomas son considerados patologías benignas de vasos linfáticos que en la cavidad bucal se manifiestan como lesiones focales superficiales. Generalmente se presentan desde el nacimiento o antes de las dos primeras décadas de vida, aparentemente sin predilección por el sexo. Dicha lesión se manifiesta como formas vesiculares cuando son superficiales y nodulares cuando son profundas. La coloración puede variar desde un color similar al tejido circundante hasta rojo azulado cuando los capilares forman parte de la malformación. Su localización intraoral más común es la cara dorsal de la lengua y bordes laterales, pudiendo provocar macroglosia. Su presentación extraoral se denomina higroma quístico y afecta el cuello. Se reporta un caso de un paciente de sexo femenino de 24 años de edad presentando lesión tumoral elevada, multilobulada, sintomática al momento de la consulta, manifestando dolor y sangramiento espontáneo. La lesión es del mismo color de la mucosa circundante, localizada en tercio medio de la cara dorsal de la lengua, dificultando la fonación y deglución. Se realizó biopsia incisional de la lesión con un diagnóstico provisional de linfangioma, obteniendo como resultado histopatológico Linfangioma.

Linphangioma are considered as benign pathologies of the lymphatic vessels, when they are evident in the oral cavity, they become superficial focal lesions. Generally, they become present at birth or before the first two decades of human life. This injury becomes apparent in different vessels forms when is superficial and nodes when is deep. Its color can vary from a similar shade of the surrounding tissue to a bluish red when capillary vessels form part, of the malformation. Its most common intra-oral location is in the dorsal face of the tongue and side edges, where it could produce macroglossia. Its extra-oral presence is designated as cystic hygroma and it affects the neck area. This is the reported case of a 24 years old female patient, who presents an elevated tumor lesion, multilobulated, and symptomatic at the time of her medical visit, with evident pain and spontaneous bleeding. The injury shows the same color of the surrounding mucous, localized in the central zone of the dorsal face of the tongue, making it difficult for swallowing and phonation. An incision biopsy of the injury was performed, with a temporary diagnosis of linphangioma, and as a histopathologic result linphangioma.

Breakfast quality and its relationship to the prevalence of overweight and obesity in adolescents in Guadalajara (Spain).

INTRODUCTION: Many young people today skip the first meal of the day in order to lose weight. OBJECTIVE: To study the impact of breakfast quality and skipping breakfast on the BMI and on the prevalence of overweight and obesity. METHOD: A nutritional study was carried out on a population of 467 secondary school students (12-17 years of age) in Guadalajara, Spain based on seven-day food journal and food frequency questionnaires. Sociodemographic data were also collected. Anthropometric measurements of weight and adiposity (BMI, percentage body fat) were also taken. RESULTS: Boys aged 15-17 ate the highest proportion of full breakfasts (18.18%), compared with 4.34% for girls the same age. Inverse relationships were recorded between breakfast energy intake and the BMI (-0.1132) and between the BMI and calcium, fibre, dairy product, and cereal intake. There was practically no correlation between protein intake and the BMI. Subjects who did not eat dairy products and those who ate cooked breakfasts had the highest BMIs. CONCLUSIONS: Skipping breakfast was not an effective way to lose weight, and weight was inversely related to breakfast quality.

[Relation between the breakfast quality and the academic performance in adolescents of Guadalajara (Castilla-La Mancha)]. / Relación entre la calidad del desayuno y el rendimiento académico en adolescentes de Guadalajara (Castilla-La Mancha).

OBJECTIVE: To study the relationship between the breakfast quality and skipping it on academic performance of a population of adolescents. METHOD: A nutritional study on the breakfast quality has been performed in a population of adolescents from Guadalajara (467 young people; age: 12-17 years) by means of questionnaires of seven-day consumption frequency. Besides, we have collected socio-demographic data and academic scores of these people. RESULTS: Most of the students interviewed take a deficient breakfast since only 4.88% have a complete breakfast. The girls aged 15-17 years are those taking the poorest quality breakfast since 8.33% of them skip this meal. 68.29% take breakfasts which quality may be improved. The breakfast quality is directly related with the mean score obtained during the course 2003-04. This relationship is not so clear-cut when the different mandatory subjects in the different academic orientations are considered since it depends on the type of subject (comprehension, memory, concentration, physical activity...). CONCLUSIONS: The population studied consumes a poor breakfast, which may affect the academic outcomes, especially those for certain subjects.

Use of protein antigens for early serological diagnosis of leprosy.

Leprosy is a chronic and debilitating human disease caused by infection with the Mycobacterium leprae bacillus. Despite the marked reduction in the number of registered worldwide leprosy cases as a result of the widespread use of multidrug therapy, the number of new cases detected each year remains relatively stable. This indicates that M. leprae is still being transmitted and that, without earlier diagnosis, M. leprae infection will continue to pose a health problem. Current diagnostic techniques, based on the appearance of clinical symptoms or of immunoglobulin M (IgM) antibodies that recognize the bacterial phenolic glycolipid I, are unable to reliably identify early-stage leprosy. In this study we examine the ability of IgG within leprosy patient sera to bind several M. leprae protein antigens. As expected, multibacillary leprosy patients provided stronger responses than paucibacillary leprosy patients. We demonstrate that the geographic locations of the patients can influence the antigens they recognize but that ML0405 and ML2331 are recognized by sera from diverse regions (the Philippines, coastal and central Brazil, and Japan). A fusion construct of these two proteins (designated leprosy IDRI diagnostic 1 [LID-1]) retained the diagnostic activity of the component antigens. Upon testing against a panel of prospective sera from individuals who developed leprosy, we determined that LID-1 was capable of diagnosing leprosy 6 to 8 months before the onset of clinical symptoms. A serological diagnostic test capable of identifying and allowing treatment of early-stage leprosy could reduce transmission, prevent functional disabilities and stigmatizing deformities, and facilitate leprosy eradication.

Fracaso de la terapéutica endoscópica en enfermos con hemorragia digestiva por úlcera duodenal / No disponible

Objetivos: analizar la eficacia de la terapéutica endoscópica en enfermos con alto riesgo de persistencia y/o recidiva del sangrado específicamente en hemorragia digestiva alta (HDA) por úlcera duodenal y determinar los factores asociados al fracaso de esta técnica. Pacientes y método: se analizaron 336 enfermos con HDA por úlcera duodenal que requirieron terapéutica endoscópica, entre enero 1992 y diciembre 2001. Se clasificaron los enfermos en función de la respuesta al tratamiento endoscópico: a) pacientes con hemorragia limitada; y b) pacientes con persistencia y/o recidiva del sangrado por fracaso terapéutico. La pauta de actuación en los enfermos con fallo del tratamiento endoscópico se hizo en función de un protocolo previamente establecido. Las variables que alcanzaron significación estadística en el análisis univariante se incluyeron en un modelo de regresión logística para identificar aquellas con un valor predictivo independiente para el fracaso de la terapéutica endoscópica. Resultados: la edad media fue de 60 ± 17 años, 271 (81%) eran hombres. La hemorragia se presentó con afectación hemodinámica grave en 82 pacientes (24%). La localización más frecuente de la úlcera duodenal fue en cara anterosuperior de bulbo duodenal en 227 pacientes (68%). En 43 enfermos (13%) la úlcera era mayor de 2 cm. Los estigmas de sangrado encontrados en la endoscopia fueron: Forrest I, en 125 (38%) y Forrest II, 211 (62%). La hemostasia inicial se logró en 297 pacientes (88%). Requirieron cirugía urgente 22 enfermos (6,5%) y la mortalidad global de nuestra serie fue del 3%. En el análisis multivariante, las variables que se asociaron independientemente al fracaso de la terapéutica endoscópica fueron la afectación hemodinámica grave al ingreso (OR 11,8, p<0,001), el tamaño de la úlcera mayor a 2 cm (OR 6,95, p= 0,019) y la presencia de sangrado activo en la endoscopia (Forrest I) (OR 3,55, p=0,08). Conclusión: la terapéutica endoscópica es eficaz en la hemorragia digestiva alta por úlcera duodenal. Mediante una variable clínica, el estado hemodinámico y dos endoscópicas, los estigmas de sangrado y el tamaño de la úlcera, podemos seleccionar un grupo de enfermos con mayor riesgo de fracaso del tratamiento endoscópico (AU)

No disponible

Axotomy-induced changes in pituitary adenylate cyclase activating polypeptide (PACAP) and PACAP receptor gene expression in the adult rat facial motor nucleus.

It has been demonstrated that pituitary adenylate cyclase activating polypeptide (PACAP) promotes the survival of neurons in culture and can inhibit neuronal cell death after experimental injury. Furthermore, peripheral axotomy results in increased PACAP gene expression in sensory and sympathetic neurons, suggesting that PACAP might be a mediator in the injury response in certain parts of the nervous system. However, changes in PACAP expression have not been reported in injured motor neurons, despite the significant problem of motor neuron degeneration in injury and in several neurological diseases. We examined here changes in gene expression of PACAP and two high-affinity PACAP receptors, PAC(1) and VPAC(2), in adult rat motor neurons after facial nerve axotomy by in situ hybridization. PACAP gene expression was very low in facial motor neurons of normal rats. However, a robust time-dependent increase in PACAP mRNA was observed in the facial motor nucleus in most or all axotomized motor neurons. This induction was detectable 6 hr after axotomy, and peaked at 48 hr, when expression on the injured side averaged more than 20-fold higher than that on the contralateral side. Thereafter, PACAP mRNA levels decreased slightly, but remained more than 10-fold elevated for as long as 30 days after axotomy. In contrast to PACAP, gene expression for both the PAC(1) and VPAC(2) receptor was high in facial motor neurons of normal rats. No significant change was observed for VPAC(2) receptor gene expression in facial motor neurons after axotomy, whereas gene expression for the PAC(1) receptor became significantly decreased. The results indicate that the PACAP ligand receptor system is tightly regulated in the facial motor nucleus after axotomy, providing evidence that PACAP may be involved in motor injury responses.

Negative CLOtest pellet can be reused.

BACKGROUND: The CLOtest is based on the production of ammonia from urea in the presence of urease. In theory, substrate that has not been consumed in a negative test can be reused. METHODS: We collected negative CLOtest pellets after their first use and stored them at room temperature. Whenever a CLOtest was needed during endoscopy, two biopsy specimens were taken from the antrum. One specimen was tested with a new CLOtest and the other with one that had been used previously. Time to color change was observed in paired tests. RESULTS: We used 216 previously used CLOtest pellets with biopsy specimens obtained from 317 patients. Of the paired tests, 204 matched positive and 108 tested negative. Only 5 paired tests had discrepant results. Three had positive results only with a new CLOtest, and 2 were positive only with the reused test. In positive paired tests, there was significant linear correlation in log-transformed color change time between reused and new tests (p < 0.001). Ninety-two percent of previously used pellets were reused fewer than three times before they yielded a positive color change; the interval to this occurrence ranged from 2 to 15 days. Compared with the new CLOtest, the sensitivity of the reused CLOtest was 98. 6% and the specificity was 98.2%. CONCLUSIONS: A negative CLOtest kept at room temperature can be reused within a short period of time, in circumstances in which there are environmental and economic considerations to be taken into account.

Detection of Epstein-Barr virus in Hodgkin's disease occurring in an Oriental population.

Like Burkitt's lymphoma, the strength of association of Epstein-Barr virus (EBV) with Hodgkin's disease occurring in different populations and clinical settings is highly variable, being 30% to 50% in Western countries, nearly 100% in Third World countries like Peru and Honduras, and nearly 100% in patients seropositive for human immunodeficiency virus. Data on the Oriental populations are very limited. Therefore, the current study was performed on the Chinese population of Hong Kong, where the incidence of Hodgkin's disease is low and EBV seroconversion occurs early in life. Twenty-three consecutive samples of Hodgkin's disease collected from 18 male and five female patients over a 12-year period were studied. The first age peak occurred in the second decade of life, and the second peak in the seventh decade. Using the sensitive and specific EBV-encoded RNAs (EBERs) in situ localization technique, positive labeling of the Reed-Sternberg cells and their variants was detected in five of five samples (100%) of mixed cellularity, nine of 16 samples (56%) of nodular sclerosing, one of one sample (100%) of lymphocyte depleted, and none of one sample (0%) of nodular lymphocyte predominant Hodgkin's disease. Further analysis of the data by age group yielded the following results: four of five (80%) for age younger than 15 years, three of nine (33%) for age 15 to 49, and eight of nine (89%) for age 50 or higher, confirming the reported strong association of EBV with Hodgkin's disease at the extremes of life. The overall positivity rate was 65%, which was intermediate between that reported in the Western populations and that in the Third World countries. These findings can be explained by the epidemiological pattern of Hodgkin's disease in Hong Kong, in which the first age peak is left-shifted to a younger age compared with that of Western populations (but not as early as that observed in Third World countries), moving the peak toward an age bracket in which Hodgkin's disease shows stronger association with EBV.

Specific association of Epstein-Barr virus with lymphoepithelial carcinoma among tumors and tumorlike lesions of the salivary gland.

The Epstein-Barr virus (EBV)-encoded RNAs in situ localization procedure is a convenient, highly sensitive, and highly specific technique that is applicable to routinely fixed, paraffin-embedded tissue sections; this technique can be used for the study of the association and, hence, the possible causal role of EBV in tumors. This study was performed to elucidate whether EBV plays a role in the pathogenesis of tumors that arise in the salivary glands, since the salivary gland is known to be a reservoir for EBV replication. Cases that were selected included 61 examples of various benign and malignant neoplasms, as well as tumorlike conditions of the major and minor salivary glands. Only the five cases of lymphoepithelial carcinoma (so-called malignant lymphoepithelial lesion) and the single case of metastatic nasopharyngeal undifferentiated carcinoma showed staining with EBV-encoded RNAs, whereas negative findings were found in all of the other cases. In the cases with positive results, all of the neoplastic epithelial cells showed strong nuclear signals, but the lymphoid cells were negative. The consistent association of EBV with lymphoepithelial carcinoma of the salivary gland suggests that the virus probably plays a causal role in this tumor, at least in the Asian population, whereas there is no evidence for a causal role of EBV in other primary tumors of the salivary gland.

Detection of Epstein-Barr viral RNA in malignant lymphomas of the upper aerodigestive tract.

Recent studies have suggested a probable etiologic association between Epstein-Barr virus (EBV) and nasal lymphomas, irrespective of geographic location. This study was performed to investigate the strength of association of EBV with non-Hodgkin's lymphomas of the upper aerodigestive tract, based on a large series of cases that have been thoroughly immunophenotyped on frozen tissues. A sensitive in situ hybridization technique was used to detect EBV encoded RNA (EBER) in paraffin sections. Among 30 cases of nasal/nasopharyngeal T-cell lymphoma, 25 (83.3%) were EBER-positive. In the positive cases, most of the neoplastic cells showed strong nuclear signals. Further analysis of this group of tumors showed that all 21 cases (100%) with a CD56+ CD3-phenotype were EBER positive, whereas four of nine cases (44.4%) with a CD56-negative immunophenotype were positive. Only one of 10 cases (10%) of nasal/nasopharyngeal B-cell lymphoma was EBER positive; the positive case was a diffuse mixed-cell lymphoma and could not be distinguished morphologically from the negative cases. Among the 21 cases of lymphoma of the tonsils and back of the tongue (20 B-lineage and one T-lineage), none was EBER positive. In the normal mucosa of the nose/nasopharynx or tonsil (20 cases studied), only very rare EBER-positive small lymphocytes were found in two cases. The almost exclusive detection of EBER in nasal/nasopharyngeal T-cell neoplasms among the lymphomas of the upper aerodigestive tract suggests that EBV probably plays an etiologic role in the pathogenesis of this group of tumors and is not simply a passenger virus, and neither is this merely a site-dependent phenomenon in view of the weak association with nasal/nasopharyngeal B-cell lymphoma.