RESUMEN
BACKGROUND: Giant cell tumors of the lumbar spine are uncommon lesions. Aggressive management of such lesions via spondylectomy to obtain local control and prevent recurrence is often necessary. Spinal reconstruction after total spondylectomy can be challenging. Traditional reconstructions typically require multisegment fixation with an association loss of segmental motion and limited 3-column reconstruction. METHODS: The authors report a case of a GCT of the lumbar spine occurring in a 49-year-old woman. The authors describe the surgical management of such a lesion via a 1-stage posterior-anterior-posterior procedure that entails a lumbar spondylectomy and short-segment posterior fixation with 3-column reconstruction using a stackable carbon-fiber-reinforced cage device with direct posterior rod connection for pedicle reconstruction. RESULTS: At 33 months postoperative follow-up, neither tumor recurrence nor instrumentation-related complications were noted, bone fusion was prevalent, and sagittal alignment was well maintained. The patient reported no loss of functions, was neurologically intact, and remained active. CONCLUSIONS: Aggressive operative management via spondylectomy of a lumbar GCT provides local tumor control. In select patients, spinal reconstruction after a spondylectomy via a 1-stage posterior-anterior-posterior approach to establish short-segment, 3-column reconstruction with recreation of the pedicles is a promising procedure that provides immediate spinal stabilization without evidence of early instrumentation-related complications, maintains spinal alignment, promotes a quick return to daily activities, and avoids sacrificing excessive motion segments and biomechanical function associated with more traditional procedures.
Asunto(s)
Tumor Óseo de Células Gigantes/cirugía , Vértebras Lumbares , Fusión Vertebral/métodos , Neoplasias de la Columna Vertebral/cirugía , Femenino , Tumor Óseo de Células Gigantes/patología , Humanos , Persona de Mediana Edad , Neoplasias de la Columna Vertebral/patologíaRESUMEN
Immunohistochemistry using a broad panel of markers is an invaluable tool for diagnosing sarcomatoid mesothelioma. Membranous podoplanin staining has been proposed as a specific and sensitive marker to distinguish epithelioid mesothelioma from adenocarcinoma. We found that cytoplasmic podoplanin staining was present in sarcomatoid mesotheliomas, and wanted to explore the reproducibility and specificity of this staining pattern. Immunohistochemistry for podoplanin, using 2 podoplanin antibodies (antipodoplanin and D2-40), was performed in 55 mesotheliomas (24 epithelioid, 18 sarcomatoid, and 13 biphasic), 80 pulmonary adenocarcinomas, 8 synovial sarcomas, and 16 sarcomatoid carcinomas. Expression of calretinin, vimentin, MOC31, and TTF-1 was also examined in all adenocarcinomas, sarcomatoid carcinomas, 7 synovial sarcomas, and 21 of the mesotheliomas. Calretinin staining performed previously on an additional 31 mesotheliomas was reviewed. Using membranous or cytoplasmic staining as indicative of positivity, we found that antipodoplanin and D2-40 each stained 84% of mesotheliomas (antipodoplanin: 46/55; D2-40: 38/44), including 72% of sarcomatoid mesotheliomas (antipodoplanin: 13/18; D2-40: 11/14). With antipodoplanin antibody, no staining was seen in the pulmonary adenocarcinomas (0/80, 0%) or the synovial sarcomas (0/8, 0%), and weak cytoplasmic staining was seen in only 1 sarcomatoid carcinoma (1/15, 7%). D2-40 showed similar results, staining 3% (2/80) of pulmonary adenocarcinomas, 13% (1/8) of synovial sarcomas, and 8% (1/13) of sarcomatoid carcinomas. Overall sensitivities and specificities were 84% and 99% for antipodoplanin, and 86% and 96% for D2-40. These findings suggest that cytoplasmic podoplanin expression may be useful in the diagnosis of sarcomatoid mesothelioma, although it should be used with caution on biopsy material.
Asunto(s)
Biomarcadores de Tumor/análisis , Glicoproteínas de Membrana/biosíntesis , Mesotelioma/metabolismo , Neoplasias Pleurales/metabolismo , Proteína G de Unión al Calcio S100/biosíntesis , Adenocarcinoma/patología , Calbindina 2 , Diagnóstico Diferencial , Humanos , Inmunohistoquímica , Neoplasias Pulmonares/patología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Análisis de Matrices TisularesRESUMEN
Bacillus anthracis edema toxin (ET), composed of protective antigen and an adenylate cyclase edema factor (EF), elicits edema in host tissues, but the target cells and events leading from EF-mediated cyclic-AMP production to edema are unknown. We evaluated the direct effect of ET on several cell types in vitro and tested the possibility that mediators of vascular leakage, such as histamine, contribute to edema in rabbits given intradermal ET. ET increased the transendothelial electrical resistance of endothelial monolayers, a response that is mechanistically inconsistent with the in vivo vascular leakage induced by ET. Screening of several drugs by intradermal treatment prior to toxin injection demonstrated reduced ET-induced vascular leakage with a cyclo-oxygenase inhibitor (indomethacin), agents that interfere with histamine (pyrilamine or cromolyn), or a neurokinin antagonist (spantide). Systemic administration of indomethacin or celecoxib (cyclo-oxygenase inhibitors), pyrilamine, aprepitant (a neurokinin 1 receptor antagonist), or indomethacin with pyrilamine significantly reduced vascular leakage associated with ET. Although the effects of pyrilamine, cromolyn, or aprepitant on ET-induced vascular leakage suggest a possible role for mast cells (MC) and sensory neurons in ET-induced edema, ET did not elicit degranulation of human skin MC or substance P release from NT2N cells in vitro. Our results indicate that ET, acting indirectly or directly on a target yet to be identified, stimulates the production/release of multiple inflammatory mediators, specifically neurokinins, prostanoids, and histamine. These mediators, individually and through complex interactions, increase vascular permeability, and interventions directed at these mediators may benefit hosts infected with B. anthracis.
Asunto(s)
Antígenos Bacterianos/toxicidad , Bacillus anthracis , Toxinas Bacterianas/toxicidad , Edema/inducido químicamente , Histamina/metabolismo , Prostaglandinas/metabolismo , Taquicininas/metabolismo , Animales , Aprepitant , Permeabilidad Capilar/efectos de los fármacos , Celecoxib , Degranulación de la Célula , Línea Celular , Modelos Animales de Enfermedad , Inhibidores Enzimáticos/farmacología , Antagonistas de los Receptores Histamínicos H1/farmacología , Humanos , Indometacina/farmacología , Inyecciones Intradérmicas , Mastocitos/efectos de los fármacos , Morfolinas/farmacología , Antagonistas del Receptor de Neuroquinina-1 , Antagonistas de Prostaglandina/farmacología , Pirazoles/farmacología , Pirilamina/farmacología , Conejos , Sustancia P/análogos & derivados , Sustancia P/metabolismo , Sustancia P/farmacología , Sulfonamidas/farmacología , Taquicininas/antagonistas & inhibidoresRESUMEN
Hibernoma is a rare benign soft tissue tumor composed of remnants of fetal brown fat. It has only rarely been reported in the literature in patients ranging in age from 2 to 75 years. We present a case of multiple hibernomas occurring in a 1-month-old infant.
Asunto(s)
Neoplasias de Cabeza y Cuello/diagnóstico , Lipoma/diagnóstico , Imagen por Resonancia Magnética , Neoplasias Primarias Secundarias/diagnóstico , Neoplasias de los Tejidos Blandos/diagnóstico , Tomografía Computarizada por Rayos X , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Recién Nacido , Lipoma/patología , Neoplasias de los Tejidos Blandos/patologíaRESUMEN
The use of spit tobacco (ST) products is a serious public health problem in the United States. Use of ST is associated with increased risk of oral cancer, gastrointestinal neoplasms, and other deleterious effects. The prevalence of ST use among adolescents is high in many areas, especially in predominantly rural states (e.g., South Dakota, Montana). Community-wide efforts aimed at prevention and cessation of ST use among young people are needed. A total of 4089 clinicians and educators were surveyed in 1998 regarding their personal ST use and several other characteristics associated with ST prevention and cessation counseling. Educators reported significantly higher rates of ST use than did clinicians. The most prevalent barriers to ST counseling among clinicians were perceptions of patient resistance to referral to ST cessation programs and the lack of community services that effectively treat ST use. Lack of training was a major barrier to ST counseling among all educator subgroups. Although knowledge of the health effects of ST was fairly high among all subgroups, more than 10% of dentists and dental hygienists failed to report that ST use causes gum disease. Most clinicians believed that they should demonstrate leadership in efforts aimed at ST control; however, only 64% of dentists believed that repeated counseling attempts were necessary with patients who continued to use ST. Compared with clinicians, educators generally felt less obligated to provide ST counseling. Eighty percent of physicians reported counseling activities, but fewer than half of the dental professionals did. More than 75% of Drug Abuse Resistance Education (DARE) officers reported having delivered ST counseling, whereas only 4% of volunteer leaders did. Fewer than 50% of educators believed that the ST program they taught was effective. Training of various professionals in ST interventions may benefit from emphasizing different issues (reduction of personal ST use, knowledge, commitment, etc.). Our findings have implications for community-based efforts aimed at controlling ST use among young people.
Asunto(s)
Consejo , Grupo de Atención al Paciente , Cese del Uso de Tabaco/métodos , Tabaquismo/rehabilitación , Tabaco sin Humo/efectos adversos , Adolescente , Adulto , Femenino , Educación en Salud , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta , Población Rural , Tabaquismo/prevención & controlRESUMEN
This study investigates adolescents' attitudes and behaviors toward cigarette smoking in Ecuador. Using social cognitive theory as a basis, the cross-sectional survey focuses attention on such social influences as the smoking habits of family members and peers, as well as on the role of cigarette advertisements. Data on prevalence of actual use, access to cigarettes, and knowledge and attitudes about smoking are also obtained. The survey was conducted during the summer of 1994 in both urban and rural areas. Fifty schools in 40 different communities participated, resulting in a sample of 2625 adolescents aged 9 to 15 years who completed the self-administered questionnaire. This study was conducted in collaboration with Amigos de las Américas (AMIGOS), an international health organization. Staff and volunteers who participated in projects conducted by AMIGOS in Ecuador worked with local health and education officials to implement the survey. Nearly 9% of students identified themselves as current smokers, 24.5% had experimented with smoking, and 61.1% had never smoked. The results varied significantly by age and gender, with older students and boys smoking at the highest rate. The smoking status of family members and peers also significantly predicted student smoking status. The results from this sample replicate findings from North American samples. Although Ecuadorian students smoke somewhat less than their American counterparts, cigarette smoking in Ecuador is a significant public health problem and clearly warrants a coordinated response. The present study points to several strategies for preventing smoking among youth.
En el presente estudio se investigan las actitudes y conductas en torno al tabaquismo de los adolescentes en Ecuador. Basándose en teorías tomadas de la sociología cognoscitiva, la encuesta transversal enfoca la atención en influencias sociales tales como los hábitos de tabaquismo de los miembros de la familia y de los pares o semejantes, así como en el papel que desempeña la propaganda de los cigarrillos. También se obtienen datos sobre la prevalencia de tabaquismo, el acceso a los cigarrillos y los conocimientos y actitudes en torno al hábito de fumar. La encuesta se llevó a cabo en el verano de 1994 en zonas urbanas y rurales. Participaron en ella 50 escuelas situadas en 40 comunidades distintas, y de ese modo se obtuvo una muestra de 2625 adolescentes entre las edades de 9 y 15 años que completaron el cuestionario autoadministrado. El estudio se efectuó en colaboración con los Amigos de las Américas (AMIGOS), organismo internacional dedicado a la salud. Los miembros del personal de planta y los voluntarios que participaron en los proyectos dirigidos por AMIGOS en el Ecuador trabajaron con los funcionarios de salud y educación de cada localidad para realizar la encuesta. Casi 9% de los estudiantes se describieron a sí mismos como fumadores activos, 24,5% habían fumado en ocasiones y 6,1% no habían fumado nunca. Los resultados mostraron grandes diferencias cuando se desglosaron por edad y sexo, ya que los estudiantes mayores de sexo masculino tuvieron las cifras más altas de tabaquismo. La situación de los miembros de la familia y de los semejantes con respecto al tabaquismo también fue un factor que permitió predecir la situación de cada estudiante con respecto al tabaquismo. Los resultados obtenidos con esta muestra son similares a los obtenidos con muestras norteamericanas. Pese a que los estudiantes ecuatorianos fuman un poco menos que sus semejantes estadounidenses, el consumo de cigarrillos en el Ecuador es un problema de salud...