Local Thrombolysis for Successful Treatment of Acute Stroke in an Adolescent with Cardiac Myxoma

Intracardiac myxomas are the most common benign cardiac tumors in adults. They are a rare source of cardiogenic embolisms and sudden death, especially in young patients. This report describes the case of a male adolescent who presented with right-sided paresis and aphasia. Magnetic resonance imaging of the brain revealed an ischemic stroke without evidence of acute bleeding. Intra-arterial local thrombolysis was immediately started. An echocardiographic screening after successful thrombolysis with a remarkable recovery of symptoms detected a thrombotic-like mass in the left atrium. The mass was excised surgically, confirmed as a benign atrial myxoma, and the patient was discharged with restitution ad integrum. Thus, contrary to some critical reports, thrombolytic therapy for acute ischemic strokes due to atrial myxomas may be safe and highly effective

Simulations of Magnetohydrodynamics and CO Formation from the Convection Zone to the Chromosphere

ABSTRACT We present the results of simulations of the formation and the evolution of carbon monoxide (CO) and of magnetic fields in the solar atmosphere, extending from the upper convection zone to the middle chromosphere. The radiation hydrodynamics code CO 5 BOLD has been extended to a magnetohydrodynamics version. Furthermore, the time-dependent treatment of chemical reaction networks has been added. Next to the time-dependent solution of the reaction network, the code accounts for the advection of the resulting particle number densities with the hydrodynamic flow field and also for the radiative cooling by carbon monoxide lines. Although the largest absolute amount of CO is located in the middle photosphere, CO is also abundant in the layers above and binds a large fraction of carbon. An exception are the hot propagating shock waves that frequently dissociate the carbon monoxide molecules. These shock waves, which are a ubiquitous phenomenon in the model chromosphere, also shape the magnetic field of these layers. As a result the chromosphere is characterised by highly dynamic magnetic filaments that are formed in the compression zone behind and along shocks. Nevertheless, the magnetic field in the chromosphere is much more homogeneous than in the photosphere below, resulting in a dynamic small-scale 'canopy' at the boundary of these layers

Simultaneous occurrence of a hepatocellular carcinoma and a hepatic non-Hodgkin’s lymphoma infiltration

To investigate the simultaneous occurrence of hepatocellular carcinoma and non-Hodgkin’s lymphoma, we report the case of a 70 year old patient with a primary diagnosis of non-Hodgkin’s lymphoma in 2002. In a routine follow up investigation of his chronic lymphocytic leukemia a newly detected mass in the Couinaud's segments 2 and 3 was found. No hepatitis C virus or hepatitis B virus infection or cirrhosis was evident. After laparoscopic segmentectomy the histological examination revealed a hepatocellular carcinoma. While the relation between liver parenchyma damages and hepatocellular carcinoma or non-Hodgkin’s lymphoma is well known, only a few publications have focused on the coexistence of hepatocellular carcinoma and non-Hodgkin’s lymphoma. With this case we demonstrate the coexistence of these diseases without having a predamaged liver parenchyma

Podoplanin expression predicts prognosis in patients with oral squamous cell carcinoma treated with neoadjuvant radiochemotherapy

Despite new therapeutic approaches patients with advanced oral squamous cell carcinoma still have a dismal prognosis. The main factor contributing to this problem is locoregional failure due to a lack of response to treatment. Several trials have proven the effect of neoadjuvant radiochemotherapy followed by radical surgery in comparison to primary surgery followed by adjuvant radiochemotherapy. No reliable parameters have been identified so far to predict response to radiochemotherapy. The aim of our study was to assess whether podoplanin expression in pretreatment biopsies could serve as a biomarker to predict the host response to neoadjuvant radiochemotherapy. In this retrospective study, podoplanin expression was examined in a set of 63 patients with oral squamous cell carcinoma by immunohistochemistry. We analyzed associations between the level of podoplanin expression and various clinicopathologic parameters, including response to radiochemotherapy, clinical and histological N-status. Furthermore we evaluated the effects of these parameters on overall survival and on locoregional control in univariate and multivariate analysis. The chi(2)-test revealed that high expression of podoplanin in pretreatment biopsy material was associated with non-regression of the tumor (p = 0.013) and poor overall survival (p < 0.001). Five-year survival rates of 92.9% for patients with weak expression and 15.0% for high expression were revealed. Podoplanin expression was also significantly associated with ypN status (p = 0.004) and ypUICC status (p < 0.001). We concluded that podoplanin might serve as a factor to predict treatment response in oral squamous cell carcinoma treated with neoadjuvant platin-based radiochemotherapy as well as a prognostic factor for overall survival and locoregional control. (C) 2011 Elsevier Ltd. All rights reserved

p16 Expression in carcinoma of unknown primary: Diagnostic indicator and prognostic marker

BackgroundCarcinoma of unknown primary (CUP) of the neck are heterogeneous tumors in their clinical and biological characteristics, and a preoperative prognostic marker is desirable to optimize staging and therapy and to improve outcome and survival. For CUP syndrome, no optimized diagnostic and treatment strategy or biomarker have yet been determined. MethodsForty-seven patients presenting with CUP syndrome were analyzed after thorough standard diagnostic staging procedures. All patients were surgically treated with tonsillectomy, neck dissection of the diseased neck, as well as adjuvant chemoradiation. The tissue of lymph node metastases (and, if found, of the primary tumor) was analyzed regarding expression of p16, epidermal growth factor receptor (EGFR), and presence of human papillomavirus (HPV) DNA. ResultsIn 39% of all cases (20 of 47), the primary cancer was found during diagnostic workup. If HPV DNA was detected in the neck lymph node metastasis, the primary cancer was significantly more frequently found in the oropharynx (p = .002). Patients with a p16-positive tumor had a significantly higher 5-year overall survival (OS; 33% vs 69%; p = .045, disease-free survival [DSF] 77% vs 89%; p = not significant [NS]). Patients with p16-positive neck metastasis and no detectable primary cancer had a better prognosis. Expression of EGFR in this series did not have a significant effect on prognosis. ConclusionIn patients presenting with CUP syndrome, p16 immunohistochemistry can serve to locate the primary cancer in the oropharynx. It is a positive prognostic indicator in patients with those heterogeneous cancers. Head Neck, 35: 1521-1526, 201

Expression of podoplanin and prognosis in oropharyngeal cancer

It has been shown that podoplanin expression is associated with carcinoma of the aerodigestive tract. Recent studies indicate that podoplanin may serve as a prognostic biomarker in oral carcinoma. In order to provide evidence on the role of podoplanin in oropharyngeal squamous cell carcinoma, we evaluated the prognostic impact of podoplanin in these patients. We analyzed formalin-fixed tissue samples from 107 consecutive patients with oropharyngeal squamous cell carcinoma. HPV typing and immunohistochemical staining for both p16 and podoplanin were performed. Expression of podoplanin was seen in 38.3 % of all cases. We found no correlation of the podoplanin scores with either p16 expression or with HPV status. There was no significant correlation of podoplanin expression with the staging variables T, N, M, and tumor grading. Podoplanin expression did neither influence the 5-year overall survival nor the 5-year disease-free survival. Concluding, we could not find a prognostic role of podoplanin expression neither in the HPV-positive cases nor in the HPV-negative cases. It appears that podoplanin is not expressed as often in oropharyngeal cancer compared to oral cancer. We could not show any relation of lymph node metastases and podoplanin expression in this homogenous cohort of tumors

NIKEI: A New Inexpensive and Non-Invasive Scoring System to Exclude Advanced Fibrosis in Patients with NAFLD

<div><p>Aims</p><p>To develop, validate and compare a non-invasive fibrosis scoring system for non-alcoholic fatty liver disease (NAFLD) derived from routinely obtained clinical and biochemical parameters.</p> <p>Methods</p><p>267 consecutive patients with biopsy proven fatty liver or non-alcoholic steatohepatitis were randomly assigned to the estimation (2/3) or validation (1/3) group to develop a model for the prediction of advanced fibrosis. Univariate statistics were performed to compare patients with and without advanced fibrosis, and following a multivariate logistic regression analysis a new scoring system was constructed. This non-invasive Koeln-Essen-index (NIKEI) was validated and compared to the FIB-4 index by calculating the area under the receiver operating characteristic curve (AUC). We evaluated a stepwise combination of both scoring systems for the precise prediction of advanced fibrosis. To set in contrast, we additionally tested the diagnostic accuracy of the AST/ALT ratio, BARD score and the NAFLD fibrosis score in our cohort.</p> <p>Results</p><p>Age, AST, AST/ALT ratio, and total bilirubin were identified as significant predictors of advanced fibrosis and used to construct the NIKEI with an AUC of 0.968 [0.937; 0.998] compared to 0.929 [0.869; 0.989] for the FIB-4 index. The absence of advanced fibrosis could be confirmed with excellent accuracy (99–100%). The positive predictive value of the FIB-4 index was higher (100% vs. 60%), however, the false negative rate was also high (33%). With a stepwise combination of both indices 82%–84% of biopsies would have been avoidable without a single misclassification. The AUROC for AST/ALT ratio, the NAFLD fibrosis score, and the BARD score were 0.81 (95% CI, 0.72–0.90), 0.96 (95% CI 0.92–0.99), and 0.67 (95% CI 0.55–0.78), respectively.</p> <p>Conclusion</p><p>The NIKEI can reliably exclude advanced fibrosis in subjects with NAFLD. In combination with the FIB-4 index misclassification with inadequate clinical management can be avoided while the need for liver biopsies can be reduced.</p> </div

Diagnostic performance of the NAFLD score.

<p>Cut-off values and the classification of patients on the basis of the NAFLD fibrosis score (n = 120). A patient with a value below the lower cut-off level was classified as healthy (no advanced fibrosis), with a value above the upper cut-off level as morbid (advanced fibrosis). Patients with values between the cut-off levels are intermediate/not classifiable.</p

Characteristics of the study population.

<p>Data are shown as mean ± SD. Percentages (%) are given in brackets and refer to patients inside of respective subset. Abbreviations: BMI  =  body mass index; AST  =  aspartate aminotransferase; ALT  =  alanine aminotransferase; GGT  =  gamma glutamyl transferase; INR  =  International normalized ratio; AFP  =  alpha-fetoprotein.</p

NIKEI test performance in estimation group (EG) and validation group (VG).

<p>Cut-off levels and the classification of patients on the basis of the individual scores within the estimation (EG) and validation group (VG). A patient with a value below the lower cut-off level was classified as healthy (no advanced fibrosis), with a value above the upper cut-off level as morbid (advanced fibrosis). Patients with values between the cut-off levels are intermediate/not classifiable.</p