RESUMEN
Milk-alkali syndrome (MAS) is one of the causes of hypercalcaemia. We report a case of a 75-year-old lady with a history of thyroidectomy, presented with an altered mental state and had an extremely high calcium concentration of 4.96mmol/L. The hypercalcemia was attributed to the ingestion of large doses of calcium supplements, including calcium carbonate and calcium lactate, leading to MAS. She was managed with intravenous fluids, diuretics and withdrawal of calcium supplements. The patient responded well to treatment and regained consciousness. Details of the case including clinical presentations, electrocardiogram (ECG) findings and treatment plan, are discussed in this article.
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Hipercalcemia , Anciano , Carbonato de Calcio/efectos adversos , Femenino , Humanos , Hipercalcemia/inducido químicamente , Hipercalcemia/diagnósticoRESUMEN
INTRODUCTION: Excessive ultraviolet light (UV) can cause premature skin aging and potentially skin cancer. Currently there is a lack of awareness among health care professionals and the public on sun protection. The objectives of this study were to determine knowledge on sunscreen and skin cancer among health care professionals, to evaluate the knowledge, attitude, practice and perception of doctors and pharmacists toward the usage of sunscreen as protection against UV radiation. MATERIALS AND METHODS: This is a cross-sectional study conducted among doctors and pharmacists in Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia. Questionnaires were used in this study. RESULTS: A total of 384 participants completed the questionnaires. The participants consisted of 323 doctors (84.1%) and 61 pharmacists (15.9%). The age group of the participants ranged between 25 till 55 years old. Ninety doctors (27.9%) and thirty-one pharmacists (51.0%) reported used sunscreen daily (p<0.001). This finding showed that there was a deficit in the practice of sun protection. Pharmacists scored a higher knowledge score of median 12 (IQR=3.0) while the doctors scored 11 (IQR=2.0). This study showed a significant association between ethnicity and skin cancer knowledge (p<0.05). CONCLUSION: This study demonstrated a lack of knowledge of sunscreen and skin cancer prevention among health care practitioners. This finding supports better medical education program on this topic.
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Neoplasias Cutáneas , Protectores Solares , Adulto , Estudios Transversales , Conocimientos, Actitudes y Práctica en Salud , Humanos , Percepción , Farmacéuticos , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/prevención & control , Protectores Solares/uso terapéutico , Encuestas y CuestionariosRESUMEN
Subcutaneous Panniculitis-like T-cell Lymphoma (SPTL) is a rare cutaneous neoplasm of mature cytotoxic T cells, first described in 1991 by Gonzalez et al. The incidence of SPTL in Asian countries ranges from 2.3% to 3%. In Malaysia, only 5 cases were reported from 2001 to 2004 in Hospital Kuala Lumpur, Malaysia. SPTL typically presents as skincoloured or erythematous subcutaneous nodules, most often on the extremities and trunk, but it can also involve the face, back and neck. Diagnosis of SPTL is made based on correlation of clinical findings and subcutaneous tissue biopsy along with immunohistochemical staining patterns.
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Ganglios Linfáticos/patología , Linfoma de Células T/diagnóstico , Paniculitis/diagnóstico , Neoplasias Cutáneas/diagnóstico , Biopsia , Diagnóstico Diferencial , Humanos , Masculino , Tejido Subcutáneo , Adulto JovenRESUMEN
We retrospectively reviewed 102 patients with esophageal cancer (97.1% squamous cell carcinoma, 96.1% stage III) received FDG-PET staging and were treated by chemoradiotherapy with or without resection to assess whether the pretreatment [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) maximum standardized uptake value (SUVmax) of the primary tumor and metastatic lymph nodes can predict the prognosis of patients with esophageal cancer. Receiver operating characteristic analysis was performed to find the cutoff values for primary tumor SUVmax and nodal SUVmax. The influence of clinical factors including primary tumor SUVmax and nodal SUVmax on local progression-free survival, nodal progression-free survival (NPFS), distant metastases-free survival (DMFS), and overall survival (OS) were evaluated using univariate and multivariate analyses. A total of 40 patients received esophagectomy after neoadjuvant chemoradiotherapy (trimodality), while 62 patients received definitive chemoradiotherapy (dCRT). The median follow-up was 26.4 months. The SUVmax of primary tumor had no significant predictive value on all outcomes, while the SUVmax of metastatic lymph nodes had predictive value on several outcomes. High nodal SUVmax (≥7) predicted for worse outcomes than low nodal SUVmax (<7) in the patients who received dCRT (two-year DMFS, 17% vs. 92%, P < 0.001; NPFS, 14% vs. 81%, P = 0.001; OS, 21% vs. 50%, P = 0.003), but not in those received trimodality. On multivariate analysis of patients receiving dCRT, nodal SUVmax was the strongest independent predictor on DMFS (hazard ratio [HR] 13.93, P < 0.001), NPFS (HR 3.99, P = 0.026), PFS (HR 2.90, P = 0.003), and OS (HR 3.80, P = 0.001). High pretreatment nodal SUVmax predicts worse treatment outcomes for the patients treated with dCRT.
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Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias Esofágicas/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Ganglios Linfáticos/diagnóstico por imagen , Tomografía de Emisión de Positrones/estadística & datos numéricos , Radiofármacos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/terapia , Quimioradioterapia , Supervivencia sin Enfermedad , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas de Esófago , Esofagectomía/métodos , Esofagectomía/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones/métodos , Valor Predictivo de las Pruebas , Pronóstico , Valores de Referencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The study aimed to construct a recombinant Lactobacillus casei expressing the nonstructural (NS) 1 protein of influenza A virus H5N1 on its cell wall. The NS1 gene was first amplified and fused to the pSGANC332 expression plasmid. The NS1 protein expression was carried out by Lact. casei strain C1. PCR screening and DNA sequencing confirmed the presence of recombinant pSG-NS1-ANC332 plasmid in Lact. casei. The plasmid was stably maintained (98·94 ± 1·65%) by the bacterium within the first 20 generations without selective pressure. The NS1 was expressed as a 49-kDa protein in association with the anchoring peptide. The yield was 1·325 ± 0·065 µg mg-1 of bacterial cells. Lactobacillus casei expressing the NS1 on its cell wall was red-fluorescently stained, but the staining was not observed on Lact. casei carrying the empty pSGANC332. The results implied that Lact. casei strain C1 is a promising host for the expression of surface-bound NS1 protein using the pSGANC332 expression plasmid. SIGNIFICANCE AND IMPACT OF THE STUDY: The study has demonstrated, for the first time, the expression of nonstructural 1 (NS1) protein of influenza A virus H5N1 on the cell wall of Lactobacillus casei using the pSGANC332 expression plasmid. Display of NS1 protein on the bacterial cell wall was evident under an immunofluorescence microscopic observation. Lactobacillus casei carrying the NS1 protein could be developed into a universal oral influenza vaccine since the NS1 is highly conserved among influenza viruses.
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Subtipo H5N1 del Virus de la Influenza A/inmunología , Vacunas contra la Influenza/genética , Gripe Humana/prevención & control , Lacticaseibacillus casei/metabolismo , Proteínas no Estructurales Virales/metabolismo , Animales , Pared Celular/genética , Pared Celular/metabolismo , Humanos , Subtipo H5N1 del Virus de la Influenza A/genética , Gripe Humana/virología , Lacticaseibacillus casei/genética , Proteínas no Estructurales Virales/genéticaRESUMEN
OBJECTIVE: Unenhanced helical CT for kidney, ureter and bladder (CT KUB) has become the standard investigation for renal colic. This study aims to determine the sensitivity of scout radiographs in detecting ureteric calculi using CT KUB as a standard reference. METHODS: A retrospective review of consecutive patients who presented with acute flank pain and were investigated using CT KUB. 201 patients with positive ureteric calculi were included. Two radiologists independently reviewed the scout radiographs with access to CT KUB images. Each observer recorded the presence or absence of calculi, location, size and mean Hounsfield units of each calculus. RESULTS: 203 ureteric calculi were analysed from 201 patients. The overall sensitivity of scout radiographs for Observer A was 42.3% and for Observer B 52.2%, with an interobserver reliability κ-value of 0.78. The significance of mean Hounsfield units and size between two groups of patients with visible stones and those not visible were tested; the p-value for both variables was <0.0001, which is statistically significant. The study found that calculi in the upper ureter and larger than 4 mm are more likely to be seen on the scout radiograph. CONCLUSIONS: Usage of CT scout radiography should be encouraged and reported routinely in conjunction with CT KUB as a baseline for treatment follow-up.
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Tomografía Computarizada Espiral , Cálculos Ureterales/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta , Estudios Retrospectivos , Sensibilidad y Especificidad , Reino Unido , Adulto JovenRESUMEN
Inflammatory myofibroblastic tumours (IMTs) of the duodenum and head of the pancreas are rare. They are of probable immunological aetiology and preoperatively indistinguishable from adenocarcinomas of the pancreatic head. We describe a patient with duodenal IMT and gastric outlet obstruction, and present a review of pancreatic head and duodenal IMTs in the literature. IMTs of the pancreatic head present as obstructive jaundice, while those of the duodenum present as gastric outlet obstruction. Surgery is the primary modality of treatment. Adjuvant chemotherapy and radiotherapy are controversial and reserved for incomplete resections and IMTs of a pathologically aggressive nature. Otherwise, recurrence is uncommon and surgery curative.
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Neoplasias Duodenales/patología , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/diagnóstico por imagen , Neoplasias Duodenales/cirugía , Duodeno/diagnóstico por imagen , Duodeno/patología , Duodeno/cirugía , Femenino , Humanos , Inflamación/patología , Persona de Mediana Edad , Miofibroblastos/patología , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patología , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Gout and hyperuricaemia attributed to genetic and lifestyle factors have been associated with several chronic diseases. This study aimed to determine the association and interaction effects between vascular endothelial growth factor receptor-2 (VEGFR-2) gene polymorphisms (rs1870377 and rs2071559) and dietary patterns on blood uric acid in Malay and Indian adults. METHODS: Dietary intakes of 153 Malays and 177 Indians were obtained using a food frequency questionnaire for the construction of dietary patterns using factor analysis. Genotyping of rs1870377 and rs2071559 was performed by real-time PCR using TaqMan probes. Anthropometric measurements, body mass index (BMI) and blood pressure and biomarkers, uric acid, glycated haemoglobin A1c (HbA1c), and blood lipids were determined. RESULTS: There were significant differences in the mean values for HbA1c (41 +/- 12 vs 45 +/- 8 mmol/mol, p < 0.001) and blood lipids levels (p < 0.05) between Malays and Indians. Significant correlations were obtained between uric acid with selected blood lipids (p < 0.05) and BMI in Malays (r = 0.362, p < 0.001) and Indians (r = 0.212, p < 0.01). Four dietary patterns were extracted from dietary intakes of all subjects: 'Vegetables diet'; 'Fruits diet' (FD); 'Animal protein and rice diet'; and 'Fast foods and preserved foods diet'. There were no significant associations between dietary patterns (p = 0.054-0.609) and VEGFR-2 gene polymorphisms (p = 0.348-0.778) with uric acid. In Malay subjects, the interaction of rs2071559 and FD had a borderline effect (p = 0.05) on blood uric acid after adjusting for potential confounders. CONCLUSION: The associations and gene-diet interactions involving VEGFR-2 gene polymorphisms and FD on uric acid provide new information on gout and hyperuricaemia risks in Malays.
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Dieta , Polimorfismo Genético , Ácido Úrico/sangre , Receptor 2 de Factores de Crecimiento Endotelial Vascular/genética , Adulto , Animales , Índice de Masa Corporal , Proteínas en la Dieta , Comida Rápida , Femenino , Alimentos , Frutas , Genotipo , Hemoglobina Glucada/análisis , Gota/etiología , Gota/genética , Humanos , Hiperuricemia/etiología , Hiperuricemia/genética , India/etnología , Lípidos/sangre , Malasia/etnología , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Encuestas y Cuestionarios , VerdurasRESUMEN
BACKGROUND AND AIMS: Diabetic foot ulcer is one of the major health problems that accounts for increased morbidity among the diabetic patients. Having good knowledge, good attitude and practice of managing the foot prevents the impending chronic co-morbidities of the disease. MATERIALS AND METHODS: This cross-sectional study was performed to assess the knowledge, attitude and practice on foot care among the newly diagnosed diabetic type 2 patients with low education and socio economic background. This study was conducted in one of the out patient clinics in a tertiary hospital. A set of questionnaire adopted from The Michigan Diabetes Research and Training Center (MDRTC), was used to assess 109 respondents based on their knowledge of diabetes mellitus, practice and attitude towards the condition and care of the feet. RESULTS: The overall finding on knowledge, practice and attitude had shown unsatisfactory result. There was no relationship between the knowledge, practice and attitude with care of the feet. Only 20 (18.3%) respondents had a high score on knowledge, 31 (28.4%) had practiced good habits and 5 (4.6%) showed positive attitude towards care of the feet. However, there was significant finding on the level of education and the knowledge of foot care (p=0.01); CONCLUSION: Strategies should be developed to overcome the longterm complications. As for the Muslim patients, ablution, the ritual practice of washing and cleaning both feet prior to the prayers may be a possible means of checking the feet for any diabetic foot complication.
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Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/etiología , Pie Diabético/terapia , Conocimientos, Actitudes y Práctica en Salud , Estudios Transversales , Escolaridad , Femenino , Humanos , Masculino , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
Maslinic acid, a natural pentacyclic triterpene has been shown to inhibit growth and induce apoptosis in some tumour cell lines. We studied the molecular response of Raji cells towards maslinic acid treatment. A proteomics approach was employed to identify the target proteins. Seventeen differentially expressed proteins including those involved in DNA replication, microtubule filament assembly, nucleo-cytoplasmic trafficking, cell signaling, energy metabolism and cytoskeletal organization were identified by MALDI TOF-TOF MS. The down-regulation of stathmin, Ran GTPase activating protein-1 (RanBP1), and microtubule associated protein RP/EB family member 1 (EB1) were confirmed by Western blotting. The study of the effect of maslinic acid on Raji cell cycle regulation showed that it induced a G1 cell cycle arrest. The differential proteomic changes in maslinic acid-treated Raji cells demonstrated that it also inhibited expression of dUTPase and stathmin which are known to induce early S and G2 cell cycle arrests. The mechanism of maslinic acid-induced cell cycle arrest may be mediated by inhibiting cyclin D1 expression and enhancing the levels of cell cycle-dependent kinase (CDK) inhibitor p21 protein. Maslinic acid suppressed nuclear factor-kappa B (NF-κB) activity which is known to stimulate expression of anti-apoptotic and cell cycle regulatory gene products. These results suggest that maslinic acid affects multiple signaling molecules and inhibits fundamental pathways regulating cell growth and survival in Raji cells.
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Puntos de Control de la Fase G1 del Ciclo Celular , Proteoma/análisis , Triterpenos/farmacología , Western Blotting , Línea Celular Tumoral , Proliferación Celular , Coleus/química , Ciclina D1/metabolismo , Inhibidor p21 de las Quinasas Dependientes de la Ciclina/metabolismo , Electroforesis en Gel Bidimensional , Humanos , Proteínas Asociadas a Microtúbulos/metabolismo , FN-kappa B/metabolismo , Proteínas Nucleares/metabolismo , Proteómica/métodos , Pirofosfatasas/metabolismo , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/métodos , Estatmina/metabolismo , Factores de TiempoRESUMEN
AIM: Present study aimed to elucidate the suppression of serum lipids by gamma- and delta-tocotrienol (γδT3). METHODS: The lipid-lowering effects of γδT3 were investigated using HepG2 liver cell line, hypercholesterolemic mice and borderline-high cholesterol patients. RESULTS: In-vitro results demonstrated two modes of action. First, γδT3 suppressed the upstream regulators of lipid homeostasis genes (DGAT2, APOB100, SREBP1/2 and HMGCR) leading to the suppression of triglycerides, cholesterol and VLDL biosyntheses. Second, γδT3 enhanced LDL efflux through induction of LDL receptor (LDLr) expression. Treatment of LDLr-deficient mice with 1 mg/day (50 mg/kg/day) γδT3 for one-month showed 28%, 19% reduction in cholesterol and triglyceride levels respectively, whereas HDL level was unaltered. The lipid-lowering effects were not affected by alpha-tocopherol (αTP). In a placebo-controlled human trial using 120 mg/day γδT3, only serum triglycerides were lowered by 28% followed by concomitant reduction in the triglyceride-rich VLDL and chylomicrons. In contrast, total cholesterol, LDL and HDL remained unchanged in treated and placebo groups. The discrepancies between in-vitro, in-vivo and human studies may be attributed to the differential rates of post-absorptive γδT3 degradation and LDL metabolism. CONCLUSION: Reduction in triglycerides synthesis and transport may be the primary benefit caused by ingesting γδT3 in human.
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Cromanos/farmacología , Lipoproteínas VLDL/metabolismo , Hígado/efectos de los fármacos , Triglicéridos/biosíntesis , Vitamina E/análogos & derivados , Animales , Apolipoproteína B-100/genética , Apolipoproteína B-100/metabolismo , Western Blotting , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/patología , Proliferación Celular , Células Cultivadas , Diacilglicerol O-Acetiltransferasa/genética , Diacilglicerol O-Acetiltransferasa/metabolismo , Femenino , Humanos , Hidroximetilglutaril-CoA Reductasas/genética , Hidroximetilglutaril-CoA Reductasas/metabolismo , Hígado/citología , Hígado/metabolismo , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patología , Masculino , Ratones , Ratones Noqueados , ARN Mensajero/genética , Receptores de LDL/fisiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Proteína 1 de Unión a los Elementos Reguladores de Esteroles/genética , Proteína 1 de Unión a los Elementos Reguladores de Esteroles/metabolismo , Proteína 2 de Unión a Elementos Reguladores de Esteroles/genética , Proteína 2 de Unión a Elementos Reguladores de Esteroles/metabolismo , Triglicéridos/metabolismo , Vitamina E/farmacologíaAsunto(s)
Cromanos/farmacología , Melaninas/biosíntesis , Monofenol Monooxigenasa/metabolismo , Piel , Vitamina E/análogos & derivados , Animales , Línea Celular , Activación Enzimática , Humanos , Ratones , Ratones Desnudos , Piel/efectos de los fármacos , Piel/metabolismo , Piel/efectos de la radiación , Rayos Ultravioleta , Vitamina E/farmacología , Ensayos Antitumor por Modelo de XenoinjertoRESUMEN
gamma-Tocotrienol (gammaT3) is known to selectively kill prostate cancer (PCa) cells and to sensitize the cells to docetaxel (DTX)-induced apoptosis. In the present study, the pharmacokinetics of gammaT3 and the in vivo cytotoxic response of androgen-independent prostate cancer (AIPCa) tumor following gammaT3 treatment were investigated. Here, we investigated these antitumor effects for PCa tumors in vivo. The pharmacokinetic and tissue distribution of gammaT3 after exogenous gammaT3 supplementation were examined. Meanwhile, the response of the tumor to gammaT3 alone or in combination with DTX were studied by real-time in vivo bioluminescent imaging and by examination of biomarkers associated with cell proliferation and apoptosis. After intraperitoneal injection, gammaT3 rapidly disappeared from the serum and was selectively deposited in the AIPCa tumor cells. Administration of gammaT3 alone for 2 weeks resulted in a significant shrinkage of the AIPCa tumors. Meanwhile, further inhibition of the AIPCa tumor growth was achieved by combined treatment of gammaT3 and DTX (p < 0.002). The in vivo cytotoxic antitumor effects induced by gammaT3 seem to be associated with a decrease in expression of cell proliferation markers (proliferating cell nuclear antigen, Ki-67 and Id1) and an increase in the rate of cancer cell apoptosis [cleaved caspase 3 and poly(ADP-ribose) polymerase]. Additionally, the combined agents may be more effective at suppressing the invasiveness of AIPCa. Overall, our results indicate that gammaT3, either alone or in combination with DTX, may provide a treatment strategy that can improve therapeutic efficacy against AIPCa while reducing the toxicity often seen in patients treated with DTX.
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Antineoplásicos/uso terapéutico , Cromanos/uso terapéutico , Neoplasias de la Próstata/tratamiento farmacológico , Vitamina E/análogos & derivados , Animales , Antineoplásicos/farmacocinética , Apoptosis/efectos de los fármacos , Cadherinas/biosíntesis , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Cromanos/farmacocinética , Relación Dosis-Respuesta a Droga , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Humanos , Masculino , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Ratones Desnudos , Trasplante de Neoplasias , Neoplasias Experimentales/tratamiento farmacológico , Distribución Tisular , Vitamina E/farmacocinética , Vitamina E/uso terapéuticoAsunto(s)
Cateterismo/instrumentación , Incontinencia Fecal/terapia , Prótesis e Implantes/efectos adversos , Fístula Rectovaginal , Cateterismo/efectos adversos , Cuidados Críticos , Femenino , Humanos , Imagen por Resonancia Magnética , Pelvis , Fístula Rectovaginal/diagnóstico , Fístula Rectovaginal/etiologíaRESUMEN
Tocotrienol-rich fraction (TRF) has demonstrated antiproliferative effect on prostate cancer (PCa) cells. To elucidate this anticancer property in PCa cells, this study aimed, first, to identify the most potent isomer for eliminating PCa cells; and second, to decipher the molecular pathway responsible for its activity. Results showed that the inhibitory effect of gamma-tocotrienol was most potent, which resulted in induction of apoptosis as evidenced by activation of pro-caspases and the presence of sub-G(1) cell population. Examination of the pro-survival genes revealed that the gamma-tocotrienol-induced cell death was associated with suppression of NF-kappaB, EGF-R and Id family proteins (Id1 and Id3). Meanwhile, gamma-tocotrienol treatment also resulted in the induction of JNK-signalling pathway and inhibition of JNK activity by a specific inhibitor (SP600125) was able to partially block the effect of gamma-tocotrienol. Interestingly, gamma-tocotrienol treatment led to suppression of mesenchymal markers and the restoration of E-cadherin and gamma-catenin expression, which was associated with suppression of cell invasion capability. Furthermore, a synergistic effect was observed when cells were co-treated with gamma-tocotrienol and Docetaxel. Our results suggested that the antiproliferative effect of gamma-tocotrienol act through multiple-signalling pathways, and demonstrated for the first time the anti-invasion and chemosensitisation effect of gamma-tocotrienol against PCa cells.
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Antineoplásicos/farmacología , Cromanos/farmacología , Neoplasias de la Próstata/tratamiento farmacológico , Transducción de Señal/efectos de los fármacos , Vitamina E/análogos & derivados , Apoptosis/efectos de los fármacos , Línea Celular Tumoral , Movimiento Celular/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Citometría de Flujo , Humanos , Masculino , Invasividad Neoplásica , Vitamina E/farmacologíaRESUMEN
Perivascular epithelioid cell tumour (PEComa) is a term applied to a family of mesenchymal tumours composed of varying proportions of spindle and epithelioid cell components associated with HMB-45 expression. PEComa rarely arises in the soft tissue, visceral organs, skin and bone. This report details an instance when a purely epithelioid PEComa arose from the right fibula of a 52-year-old Chinese woman without features of tuberous sclerosis complex. The excision specimen disclosed an epithelioid tumour with a nested pattern associated with areas of nuclear pleomorphism, mitotic activity, necrosis and vascular invasion in addition to HMB-45 expression on immunohistochemistry. To the best of the authors' knowledge, this represents the first case of a histologically malignant PEComa of the bone. A short review of primary bone PEComas and potential problems in diagnosis is presented.
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Neoplasias Óseas/patología , Carcinoma/patología , Peroné/patología , Neoplasias Óseas/cirugía , Carcinoma/cirugía , Células Epitelioides/patología , Femenino , Humanos , Microscopía Electrónica , Persona de Mediana EdadRESUMEN
BACKGROUND: Transient elastography (TE) is a reliable non-invasive predictor of hepatic fibrosis, but data on TE in Asians are limited. AIM: To evaluate prospectively the accuracy of TE for diagnosis of hepatic fibrosis in Asians compared with APRI (aspartate transaminase to platelet ratio index). METHODS: One hundred and twenty consecutive patients who underwent liver biopsy were enrolled. TE (Fibroscan) was performed by two independent operators. Fibrosis was graded by two independent pathologists using the METAVIR classification. Area under receiver operating curves (AUROC) were used to evaluate the accuracy of TE and APRI in diagnosing significant fibrosis (F >or= 2) and cirrhosis (F4). RESULTS: Predominant aetiologies were hepatitis B (48%), non-alcoholic steatohepatitis (14%) and hepatitis C (8%). TE was unsuccessful in five patients (4.2%) because of small inter-costal space (three patients), obesity and ascites. There was good correlation between TE and fibrosis (r = 0.606). AUROC for diagnosis of significant fibrosis was 0.856 (95% CI 0.779-0.932) for TE and 0.673 (95% CI 0.568-0.777) for APRI. AUROC for diagnosis of cirrhosis was 0.924 (95% CI 0.857-0.990) for TE and 0.626 (95% CI 0.437-0.815) for APRI. Optimal TE value was 9.0 kPa for diagnosis of significant fibrosis and 16.0 kPa for cirrhosis with specificity/sensitivity/PPV/NPV/accuracy of 82.6%/85.2%/80.9%/86.7%/84.1% and 88.9%/82.7%/32.0%/98.8%/83.2%, respectively. CONCLUSIONS: Transient elastography is a reliable predictor of hepatic fibrosis in Asians. Failure of TE in Asians is commonly because of small inter-costal space. TE is superior to APRI for non-invasive diagnosis of hepatic fibrosis and cirrhosis.
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Pueblo Asiatico/etnología , Aspartato Aminotransferasas/metabolismo , Diagnóstico por Imagen de Elasticidad/instrumentación , Cirrosis Hepática/diagnóstico , Hígado/patología , Adulto , Anciano , Biopsia/normas , Elasticidad , Femenino , Humanos , Cirrosis Hepática/etnología , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
A cross-sectional study was conducted among 13 female children and 40 adolescents residing in a welfare home. The objectives of this study were to determine underweight, overweight rates and body fat percentages as well as assess the dietary intake of energy, selected macro- and micro-nutrients among the subjects aged 6-17 years. The anthropometric measurements collected were Body Mass Index (BMI) and skinfold thickness of five body sites - triceps, subscapular, abdomen, suprailiac, and thigh. Dietary intake was assessed using a 24-hour dietary recall. This study indicated that the majority (75%) of the subjects were of normal weight, 21% were underweight and 4% were overweight. BMI and body fat percentages of the adolescents were found to be significantly higher than those of the children (t=-3.083, p=0.003; t=-7.321, p<0.001). A positive correlation between BMI and body fat percentage was also significant (r=0.791, p<0.001). In terms of dietary assessment, there were significant differences in percentage of RNI attainment between children and adolescents for energy, protein, iron, and folate (p<0.05). In conclusion, the majority of the children and adolescents had normal weight and average body fat percentages. Besides, all the children met the RNI requirements for all the studied nutrients while the adolescents met the RNI requirements for energy, protein, iron, and zinc with dietary calcium and folate slightly below the RNI requirements.
Asunto(s)
Adenoma Pleomórfico/patología , Tumor Mixto Maligno/patología , Neoplasias de las Glándulas Salivales/patología , Neoplasias de la Tráquea/patología , Adenoma Pleomórfico/cirugía , Anciano , Pueblo Asiatico , Carcinoma Adenoide Quístico/patología , Diagnóstico Diferencial , Humanos , Masculino , Tumor Mixto Maligno/cirugía , Enfermedad Pulmonar Obstructiva Crónica/patología , Neoplasias de las Glándulas Salivales/cirugía , Fumar , Neoplasias de la Tráquea/cirugíaRESUMEN
Perioperative volume replacement after cardiopulmonary bypass is complicated by post-bypass systemic inflammatory process. The aim of this study was to assess the effects of using two different colloid solutions as priming fluids in cardiopulmonary bypass. The study's primary end point was to measure the amount of fluid replacement needed during and post-cardiopulmonary bypass; blood loss, change in blood profile and intraocular pressure were secondary end points, used as measures of plasma oncotic pressures. Patients undergoing coronary artery bypass grafting were recruited. Both patients and surgeons were blinded to receive either Gelofusine or Voluven as priming fluids. At fixed intervals during cardiopulmonary bypass, the patients had their intraocular pressures measured. Intra and postoperative fluid replacement was in the form of 4.5% human albumin and the amount was recorded for each subject. The result did not show any significant differences in the amount of fluid needed to be replaced, in blood loss or in blood profile between the two groups. However, it showed an increase in intraocular pressure in both groups once cardiopulmonary bypass commenced. The average intraocular pressure was higher in the Gelofusine group compared to the Voluven group. The significant increase in intraocular pressure measurements in the Gelofusine group compared to the Voluven group support the hypothesis that Voluven maintains the plasma oncotic pressure better and reduces fluid shift.