Clinical and pathological characteristics of mycobacterial tenosynovitis and arthritis.

PURPOSE: To investigate the clinical characteristics and pathological features of patients with mycobacterial tenosynovitis and arthritis. METHODS: All patients with tenosynovitis and arthritis caused by Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM) who were treated at a medical center in Taiwan from 2001 to 2010 were analyzed. RESULTS: Thirty-two patients with mycobacterial tenosynovitis and arthritis were identified. MTB was isolated exclusively from patients with arthritis of large joints (n = 11), while NTM were isolated from patients with arthritis of large joints (n = 4) and from those with tenosynovitis (n = 17). Among patients with tenosynovitis due to NTM, the most commonly found NTM were M. marinum (n = 7), M. intracellulare (n = 5), and M. abscessus (sensu stricto) (n = 2). Six of the seven patients with tenosynovitis due to M. marinum had suffered fishing-related injuries to the hands. All four patients with NTM arthritis had recurrent septic arthritis after surgery. NTM were isolated once from the debrided tissue specimens in three of these patients; the other patient died of systemic infection caused by M. intracellulare and multiple bacterial pathogens. CONCLUSION: Mycobacterial tenosynovitis should be considered in patients who present with indolent symptoms of chronic tenosynovitis. Complete clinical information, including history of trauma or joint replacement surgery and underlying systemic disease, is helpful in establishing an early diagnosis of the disease.

High-dose tamoxifen plus ifosfamide and anthracycline in a patient with angiosarcoma of the breast.

Although breast cancer is, unfortunately, not uncommon in women, a mere 0.04% of malignant breast tumours are primary angiosarcomas. Chemotherapy is advocated for treatment of breast angiosarcomas; however, no guidelines exist regarding optimal chemotherapeutics or protocols. Presently, the prognosis for breast angiosarcomas is poor. This case report describes a 24-year old woman diagnosed with primary breast angiosarcoma. She initially refused to receive treatment, but later returned to the hospital four years later with a haemopneumothorax. She was treated with rescue chemotherapy using a combination of high-dose tamoxifen plus ifosfamide and epirubicin (an anthracycline). She achieved a partial response, but died 16 months after therapy was initiated. More research is needed to devise novel chemotherapeutics and protocols to improve outcomes in women diagnosed with primary angiosarcomas of the breast.

Quaternary ZnCdSeTe nanowires.

We report the growth of needle-like high density quaternary ZnCdSeTe nanowires on oxidized Si(100) substrate using vapor-liquid-solid mechanism by molecular beam epitaxy with an Au-based nanocatalyst. It was found that average length and average diameter of the nanowires were 1.3 microm and 91 nm, respectively. It was also found that the as-grown ZnCdSeTe nanowires exhibit mixture of cubic zinc-blende and hexagonal wurtzite structures. Energy depersive results indicate that composition ratio of our nanowire should be Zn0.87Cd0.13Se0.98Te0.02, which agrees excellently with the designated composition ratio of Zn0.87Cd0.13Se0.98Te0.02.

Involvement of matrix metalloproteinase-13 in stromal-cell-derived factor 1 alpha-directed invasion of human basal cell carcinoma cells.

Basal cell carcinoma (BCC) is one of the most common skin neoplasms in humans and is usually characterized by local aggressiveness with little metastatic potential, although deep invasion, recurrence, and regional and distant metastases may occur. Here, we studied the mechanism of BCC invasion. We found that human BCC tissues and a BCC cell line had significant expression of CXCR4, which was higher in invasive than non-invasive BCC types. Further, of 19 recurrent tumors among 390 BCCs diagnosed during the past 12 years, 17/19 (89.5%) had high CXCR4 expression. We found that the CXCR4 ligand, stromal-cell-derived factor 1alpha (SDF-1alpha), directed BCC invasion and that this was mediated by time-dependent upregulation of mRNA expression and gelatinase activity of matrix metalloproteinase-13 (MMP-13). The transcriptional regulation of MMP-13 by SDF-1alpha was mediated by phosphorylation of extracellular signal-related kinase 1/2 and activation of the AP-1 component c-Jun. Finally, CXCR4-transfected BCC cells injected into nude mice induced aggressive BCCs that co-expressed CXCR4 and MMP-13. The identification of SDF-1alpha/CXCR4 as an important factor in BCC invasiveness may contribute insight into mechanisms involved in the aggressive potential of human BCC and may improve therapy for invasive BCCs.

Imprint cytology improves accuracy of computed tomography-guided percutaneous transthoracic needle biopsy.

The aim of the present study was to investigate whether imprint cytology can improve the diagnostic accuracy of computed tomography-guided transthoracic core biopsy. Between October 1997 and June 2004, thoracic lesions in 622 patients underwent biopsy using 19-gauge coaxial guiding needles and 20-gauge biopsy needles under computed tomography guidance. Touch imprint cytology and histopathology were performed for all biopsy specimens. Of these lesions, 431 (74.1%) were diagnosed as malignant, 151 (25.9%) as benign and 40 (6%) as nondiagnostic. Imprint cytology plus histology shows an improved diagnostic accuracy of 96.4% compared with that of imprint cytology alone (92.3%) or histopathology alone (93.0%). Procedure-related complications requiring further treatment occurred in eight (1.4%) patients. In conclusion, imprint cytology combined with histopathology can improve the diagnostic accuracy of computed tomography-guided transthoracic needle biopsy.

Fetal gender screening by ultrasound at 11 to 13(+6) weeks.

BACKGROUND: To survey the accuracy of fetal gender determination during first trimester screening and scan for congenital anomalies. METHODS: A prospective observational study was performed on 496 singleton pregnancies at the first trimester ultrasound screening. The doctor was a certified sonographer of first trimester screening by the Fetal Medicine Foundation(FMF). Ultrasound examination was performed on a GE Voluson 730 Pro, transabdominally, between 11 and 13(+6) weeks. Both transverse and mid-sagittal planes of a section of the fetal genital tubercle were performed to identify the gender. The subsequent gender at birth was obtained from karyotyping reports or hospital birth records. RESULTS: During the study, 496 patients requested gender information at the time of first trimester screening. Of the patients it was possible to determine gender (441 out of 496), the scan achieved an overall success rate of 91.8% in correctly identifying gender. The success rate for correctly identifying fetal gender (where identification was possible) increased with gestational age, from 71.9% at 11 weeks, 92% at 12 weeks, and 98.3% at 13 weeks, respectively, where gestational age was calculated from the crown-rump length in conjunction with menstrual or ovulation dating (p<0.001). Of the 55 cases where no identification of gender was possible, 39 were in the 11-week gestational age group, representing 40.6% of this category. The overall fetal gender accuracy rate for male fetus was slightly better than female (92.5 versus 91.2%), but was not statistically significant. CONCLUSIONS: This study demonstrated that the gestational age of the fetus has a material effect on the accuracy rate of gender determination. At 12 weeks and over, the average success rate for correctly identifying gender, where gender identification was possible, was 94.8%, with the accuracy at 13 weeks of 98.3% approaching that achieved by invasive testing. Fetal gender identification at 11

Increased Ki-67 proliferative index and absence of P16INK4 in CIN-HPV related pathogenic pathways different from cervical squamous intraepithelial lesion.

BACKGROUND/AIM: It is generally assumed that similar pathways are involved in human papillomavirus (HPV) induced pathogenesis of cervical squamous intraepithelial lesions (SILs) and cancers and a subset of conjunctival intraepithelial neoplasm (CIN)-that the malignancies or pre-cancerous lesions arise through HPV oncoproteins E6 and E7, which disrupt the pathways of p53 and the product of the retinoblastoma (Rb) gene and, in turn, increase the protein product of gene p16INK4 through the mechanism of positive feedback. Several cell cycle molecules are detected to test this hypothesis. METHODS: Nine cases of CIN and eight non-CIN cases were analysed for the expression of Ki-67, pRb, p53, and p16INK4 via immunohistochemistry. Nine cases of cervical high grade squamous intraepithelial lesion (HSIL), and 10 cases of cervical low grade squamous intraepithelial lesion (LSIL) were included for stain control of p16INK4a, and comparison of p16INK4a expression to CIN cases. A nested polymerase chain reaction and a genechip HPV typing were used to detect HPV infection and types in the CIN and non-CIN samples RESULTS: HPV positivity was demonstrated in all of the CIN lesions but in none of the non-CIN lesions. The Ki-67 proliferative index (Ki-67 PI) was statistically higher in the CIN group than the non-CIN group; however, there were no differences of expression of pRb and p53 between the two groups and no expression of p16INK4 in all cases. All nine cases of HSIL, and seven out of 10 cases of LSIL used for stain control were immunoreactive for p16INK4a. There were statistically significant differences in overexpression of p16INK4a between the CINs and SILs CONCLUSIONS: The Ki-67 proliferative index may be a sensitive marker for CIN lesions and these results, with significant differences in overexpression of p16INK4a between CINs and SILs, may provide new evidence that HPV related mucosal dysplasia in different anatomical locations may lead to dissimilar molecular pathways.

Characterization of acute myeloid leukemia with MLL rearrangements--no increase in the incidence of coexpression of lymphoid-associated antigens on leukemic blasts.

MLL gene rearrangements are associated with coexpression of myeloid- and lymphoid-associated antigens on leukemic blasts and a dismal outcome in acute lymphoblastic leukemia (ALL). Whether the same conditions can apply to acute myeloid leukemia (AML) is not quite clear. Rearrangements of the MLL gene were analyzed on 113 patients with newly diagnosed de novo AML in a single institution. Sixteen (14%) of them showed rearranged bands by Southern blot analysis, including three (50%) of six infants, three (14%) of 21 children between 1 and 15 years and 10 (12%) of 86 adults. MLL rearrangements were not only detected in M5 (four of 12 patients, 33%) and M4 (six of 31, 19%) subtypes but also in other non-M4-M5 AML (six of 70, 9%), including M1, M2 and M7, but not M3 subtype. Seven patients had chromosomal abnormalities involving 11q23, but nine did not. The latter comprised three (6%) of 48 patients with normal karyotype, one with t(8;21), none with t(15;17), inv(16) or t(9;22), and four (15%) of 27 with cytogenetic aberrations other than those specific structural abnormalities. In contrast to ALL, AML patients with MLL rearrangements did not tend to coexpress lymphoid- and myeloid-associated antigens simultaneously on leukemic blasts and have similar outcome as those without the gene rearrangements.

Epstein-Barr virus-associated intravascular lymphomatosis within Kaposi's sarcoma in an AIDS patient.

Intravascular lymphomatosis (IL) is an unusual neoplasm characterized by multifocal proliferation of lymphoma cells exclusively within the blood vessels. We report here a patient with acquired immunodeficiency syndrome (AIDS) and disseminated Kaposi's sarcoma. A 233-bp amplification product of HHV-8 was detected in the DNA extracted from specimens of Kaposi's sarcoma at different sites by polymerase chain reaction (PCR). At autopsy, the vessels within the Kaposi's sarcoma were dilated and filled with atypical large mononuclear cells. No such feature was seen in the vessels of non-Kaposi's sarcomatous regions. Immunohistochemically, the spindle cells of Kaposi's sarcoma were positive for CD31 (endothelial cell marker). The intravascular tumor cells were positive for CD45 (leukocyte common antigen) but negative for others, including chloroacetate esterase, CD45-RO (UCHL-1, Pan-T), CD3, CD43, CD20 (L26, Pan-B), CD30 (Ki-1), immunoglobulin heavy chains and light chains, CD56 (natural killer cell antigen), and CD31. Monoclonal rearrangement of immunoglobulin heavy chain gene was detected in the DNA extracts from fresh tissue of Kaposi's sarcoma by PCR, which indicated that the lymphoma cells within the Kaposi's sarcoma were of monoclonal B cell origin. In situ hybridization revealed that EBER-1 transcripts were present in the lymphoma cells of IL but not in the spindle cells of Kaposi's sarcoma. To the authors' best knowledge, this is the first instance of IL in an AIDS patient with direct evidence of EBV association.

Intrascleral dissemination of infectious scleritis following pterygium excision.

AIMS: To assess the clinical pictures, possible pathogenesis, management, and therapy of patients with infectious scleritis associated with multifocal scleral abscesses following pterygium excision. METHODS: The records of patients with infectious scleritis after pterygium excision who developed multifocal scleral abscesses presenting from 1988 to the end of 1995 were reviewed. Early culture of abscesses was performed, and topical, systemic antimicrobials, or both were given to all patients. Fourteen eyes were operated on in addition to antimicrobial treatment. RESULTS: The initial culture reports of scleral ulcers identified Pseudomonas species in 12 of these 18 patients, Aspergillus in one, Mycobacterium fortuitum in one, and mixed organisms in four. Subsequent abscess cultures were taken from 15 of the infected eyes, and revealed the same organism as the initial culture in 12. Associated complications included four serous retinal detachments, three choroidal detachments, two double detachments, five complicated cataracts, and four recurrences of the initial infection. Four eyes required eventual enucleation and 11 eyes regained useful vision. CONCLUSIONS: With subsequent abscess cultures proving to be the same organism as found in the initial ulcer, the abscess formation appears to represent intrascleral dissemination. Early diagnosis and appropriate, prolonged topical plus systemic antimicrobial treatment are essential to halt the progression of such severe infections.

Fluorescent probe study of sulfonamide binding to povidone.

The possibility of using a fluorescent probe technique for the study of drug-providone (I) interactions was investigated. 1-Anilino-8-naphthalenesulfonate (II) was used as the probe. Sulfanilamide, sulfacetamide, and sulfabenzamide were used as the binding competitors. Both sulfacetamide and sulfabenzamide decreased the fluorescence intensity of the I-II complex, while sulfanilamide increased the intensity. The fluorescence depression was greater with sulfabenzamide than with sulfacetamide, indicating that the former is more strongly bound to povidone. Since sulfabenzamide has a greater hydrophobic group (phenyl) than sulfacetamide (methyl), the binding of these sulfonamides to povidone is probably at least partially hydrophobic in nature. The enhanced fluorescence intensity of the I-II complex in the presence of sulfanilamide is believed to involve hydrogen bonding in which the sulfanilamide acts as an intermediary between I and II. Double reciprocal plots for the I-II and sulfonamide-I interactions were employed to obtain a binding constant of 3.2 X 10(4) M-1 for the I-II interaction. The association constants for sulfacetamide and sulfabenzamide were calculated by means of the Klotz equation to be 13.4 and 56.8 M-1, respectively. The povidone molecules appear to have 1.28 binding sites for these compounds under the experimental conditions.

Intraocular lens implantation after penetrating keratoplasty.

PURPOSE: We evaluated the clinical results of nonsimultaneous penetrating keratoplasty, cataract extraction, and intraocular lens (IOL) implantation (two-stage surgery) for combined corneal disease and cataract. METHODS: Twenty-six eyes of 24 patients with an average age of 46 years who underwent two-stage surgery were studied retrospectively. Variables included visual acuity, refractive status, specular microscopy before and after IOL implantation (6 months), and the occurrence of graft failure. Astigmatism was corrected by suture removal and relaxing incision. The mean follow-up after IOL placement was 16 months. RESULTS: Unaided visual acuity was 20/100 or better in 22 (83%) eyes after the second procedure. Twenty-one (81%) eyes had an aided visual acuity of at least 20/40. The mean refractive and absolute errors were -1.49 +/- 1.39 diopters (D) and 1.55 +/- 1.30 D, respectively. The mean keratometric and refractive cylinders were 3.50 D and 2.26 D, respectively. Nineteen (73%) eyes had a spherical equivalent refraction within 2 D of emmetropia. Anisometropia (> or =3 D) occurred in four (15%) eyes. The endothelial cell density, the coefficient of variation, and the percentage of hexagonal cells documented by specular microscopy were not significantly different before and after IOL implantation. Complications included three rejections, two cases of herpetic recurrence, and one late decompensation. Two graft failures (8%) occurred after secondary surgery. CONCLUSION: The two-stage surgery is a safe and effective modality.

The cycloplegic effects of cyclopentolate and tropicamide on myopic children.

Thirty-seven myopic children were given either 1-2 drops of 1% cyclopentolate or 1% tropicamide twice with 5 min intervals to evaluate the time course and maximal cycloplegic effect of both agents. The other fifteen subjects were given 1% tropicamide initially, then 1% cyclopentolate given after 30 min of maximal effect of tropicamide appeared to evaluate whether the effect of cyclopentolate was superior to tropicamide. Cycloplegic refraction was measured with an auto-refractometer (Topcon RK-3000) before drug delivery and every 15 min thereafter, for 90 min. The maximal cycloplegic effect of cyclopentolate was around 45 min, then it remained stable until 90 min after the last instillation. The effect of tropicamide was faster than that of cyclopentolate. It was around 30 min, then it stabilized until 75 min. The extra effect of cyclopentolate over tropicamide was minimal (only -0.1D). The power of cornea and astigmatism were not affected by either agent. However, a big variation in astigmatism was noted during the course, especially with cyclopentolate. This study suggests that 1% tropicamide should be a good agent for routine refractive status checking on myopic children.

Immunohistochemical and ultrastructural study of malignant plasmacytoid myoepithelioma of the maxillary sinus.

Myoepithelioma is a rare salivary gland tumor which is composed exclusively of myoepithelial cells. Histologically, it can be divided into three cell types: spindle, plasmacytoid and mixed type. Malignant myoepithelioma is characterized by invasive growth. In March 1995, a 60-year-old man presented with a left cheek tumor which he had first noted 2 years previously. Computed tomography revealed a large expansile tumor in the maxillary sinus with invasion into the surrounding soft tissue. Partial resection of the tumor was performed because of extensive involvement of the surrounding tissue. The patient died due to spread to the brain 5 months after surgery. Histologically, the tumor was composed exclusively of plasmacytoid cells, with bone destruction. Immunohistochemically, these cells were negative for immunoglobulin light chains (kappa and lambda) and heavy chains (Ig G, A, M) but positive for S-100, cytokeratin, actin and vimentin.Ultrastructurally, the tumor cells contained numerous randomly oriented actin-like microfilaments in the cytoplasm, and had desmosomes on the cell membrane. Malignant plasmacytoid myoepithelioma of the maxillary sinus was diagnosed. In addition to our case, only five cases of pure plasmacytoid myoepithelioma have been reported. Plasmacytoid myoepithelioma tends to occur in the minor salivary glands and has more aggressive behavior than spindle cell myoepithelioma. Morphologically, it is very difficult to differentiate plasmacytoid myoepithelioma from plasmacytoma and immunohistochemical staining is necessary to make a correct diagnosis.

Recurrent cardiac myxoma with multiple distant metastasis and malignant change.

A 37 year-old female underwent open heart surgery for a left atrial myxoma. The post-operative course was uneventful and she was discharged two weeks later. She had regular monthly follow-up in the outpatient department until 10 months postoperatively when she was readmitted to the orthopedic ward for excision of a left ankle tumor. Two days after admission, she developed severe orthopnea. The initial diagnosis was heart failure, and she was transferred to the medical ward for treatment. Transthoracic and transesophageal echocardiography revealed a recurrent left atrial tumor. Because of acute obstruction of the mitral valve and deterioration of her condition, she underwent emergent open heart surgery. The recurrent atrial tumor was excised; histopathologic examination revealed a myxoid sarcoma. Multiple tumors were found on this admission, including a mass in the neck and in the left forearm; computed tomography revealed a brain tumor in the left posterior frontal lobe and a chest wall tumor. She died two months later. Recurrent cardiac myxoma with multiple distant metastasis may have a malignant potential. Because of the potential for tumor recurrence, long-term and regular follow-up is mandatory.

Detection and sequence analysis of a new herpesvirus-like agent in AIDS and non-AIDS Kaposi's sarcoma in Taiwan.

A new herpesvirus-like DNA sequence (KSHV) has been recently identified in Kaposi's sarcoma from acquired immunodeficiency syndrome (AIDS) and non-AIDS patients. In order to verify the role of this new viral agent in Taiwan, a series of Kaposi's sarcoma specimens obtained from AIDS and non-AIDS patients in three medical centers representing different geographic locations of Taiwan were surveyed. A total of seven specimens from AIDS patients and 22 specimens from non-AIDS patients were tested for the presence of this herpesvirus-like agent by polymerase chain reaction (PCR) using the published Kaposi's sarcoma 330-233 primers. The tumor DNA was also tested for cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpes-virus type 6 (HHV-6). The Kaposi's sarcoma specimens from AIDS and non-AIDS patients were positive for KSHV except in one case. Only occasional specimens were positive for CMV and EBV, with a slightly higher positive rate for HHV-6 in AIDS and non-AIDS patients. Cloning and sequence analysis of the PCR products from two cases of Kaposi's sarcoma (one each for AIDS and non-AIDS) revealed only minor differences in this DNA sequence, as compared with the published data from north America. These results further support the assumption that this new KSHV is strongly associated with Kaposi's sarcoma in AIDS and non-AIDS patients in Taiwan.