Secondary recurrent multiple EGIST of the mesentary: A case report and review of the literature

AbstractINTRODUCTIONGastrointestinal stromal tumors (GISTs) are rare intra-abdominal tumors arising from mesenchymal stromal cells. EGISTs are mesenchymal tumors that originate outside the GI tract and tend to have similar characteristics to GISTs. To the best of our knowledge, few cases of long standing recurrent EGIST have been reported.PRESENTATION OF CASEWe present the case of a rare recurrent EGIST in the mesentery of a 39 year old female patient. The tumor was symptomatic at the time of complaint and measured 8.4cm×7.7cm×7.6cm. Histological analysis revealed a spindled pattern with fusiform cells arranged in long fascicles and little atypia. Immunochemistry showed positivity for CD117 and was negative for CD34, S-100, Desmin, and MSA. B-catenin was weakly positive. A Ki-67 staining shows approximately 5% positivity revealing a low proliferative rate. The patient was doing well postoperatively and was discharged on 400mg imanitib regimen.DISCUSSIONWhile GISTs are the most common tumors of the GI tract, recurrent EGISTs of the mesentery are extremely rare. Factors that indicate poor prognosis include tumor size greater than 5cm, mitotic rate greater than 1–5/10 HPF, presence of tumor necrosis or metastasis and most recently the c-kit mutation. Our patient had a very long time between recurrence of disease.CONCLUSIONThe current literature on EGISTs is limited. Our patient presents a very interesting case due to the time elapsed between disease recurrence and lack of metastasis or excessive growth

Transnational Legal Practice 2008

The current financial turmoil shaking the world illustrates the connectedness of national markets and economies. Legal practice is no exception: lawyers and their firms are experiencing the upheaval along with their clients.1 This has resulted in new opportunities for lawyers and firms–in bankruptcy and restructuring and, likely in the future, in regulatory advising as well–and, at the same time, in substantial challenges. The promise of benefits from a diversified practice–in terms of both substance and geography–is being tested as lawyers and law firms follow their clients through the uncertainties of the current economic conditions. As law firms cut the size of their legal and non-legal staffs and decrease compensation expectations, they also are capitalizing on the benefits of a geographically diverse footprint of practice by looking to overseas activities as opportunities for growth. The number of firms announcing new offices in the Middle East, for example, has not slowed during the economic crisis.2 Over the last twenty years or so, the growth of overseas activities of the largest U.S.-based law firms has far outpaced their growth within the United States, by a rate of ten-to-one.3 In 2007, more than 15,000 lawyers worked for the National Law Journal 250 firms in more than 550 offices located outside the United States.4 Indeed, two U.S.-based law firms with substantial investments in overseas offices joined the ranks of four of the London “Magic Circle” firms in a new category dubbed the “global elite.”5 But the description so far relates only to the most visible part of the story of the importance of overseas-related work for U.S. lawyers. Overseas-related work also supports lawyers working for firms that do not have formal international footprints. These may be firms with foreign clients or U.S.-based clients involved in offshore activities or partnerships. They may be firms that are members of international networks or associations of lawyers that serve as a source of referral relationships, among other things. Each of these arrangements points to the continuing importance of keeping watch over the regulatory and business environment for lawyers outside the United States. The U.S. Department of Commerce Bureau of Economic Analysis estimates that the export of U.S. legal services generated $6.4 billion in receipts in 2007, while imports of legal services were valued at nearly$1.6 billion, yielding a four-to-one surplus for balance-of-payment accounts.6 If globalization continues, as appears likely, lawyers may be able to rely on overseas activities as a sort of hedge against instability at home. Access to overseas legal markets, then, remains an issue of high priority

Transnational Legal Practice 2008

The current financial turmoil shaking the world illustrates the connectedness of national markets and economies. Legal practice is no exception: lawyers and their firms are experiencing the upheaval along with their clients.1 This has resulted in new opportunities for lawyers and firms–in bankruptcy and restructuring and, likely in the future, in regulatory advising as well–and, at the same time, in substantial challenges. The promise of benefits from a diversified practice–in terms of both substance and geography–is being tested as lawyers and law firms follow their clients through the uncertainties of the current economic conditions. As law firms cut the size of their legal and non-legal staffs and decrease compensation expectations, they also are capitalizing on the benefits of a geographically diverse footprint of practice by looking to overseas activities as opportunities for growth. The number of firms announcing new offices in the Middle East, for example, has not slowed during the economic crisis.2 Over the last twenty years or so, the growth of overseas activities of the largest U.S.-based law firms has far outpaced their growth within the United States, by a rate of ten-to-one.3 In 2007, more than 15,000 lawyers worked for the National Law Journal 250 firms in more than 550 offices located outside the United States.4 Indeed, two U.S.-based law firms with substantial investments in overseas offices joined the ranks of four of the London “Magic Circle” firms in a new category dubbed the “global elite.”5 But the description so far relates only to the most visible part of the story of the importance of overseas-related work for U.S. lawyers. Overseas-related work also supports lawyers working for firms that do not have formal international footprints. These may be firms with foreign clients or U.S.-based clients involved in offshore activities or partnerships. They may be firms that are members of international networks or associations of lawyers that serve as a source of referral relationships, among other things. Each of these arrangements points to the continuing importance of keeping watch over the regulatory and business environment for lawyers outside the United States. The U.S. Department of Commerce Bureau of Economic Analysis estimates that the export of U.S. legal services generated $6.4 billion in receipts in 2007, while imports of legal services were valued at nearly$1.6 billion, yielding a four-to-one surplus for balance-of-payment accounts.6 If globalization continues, as appears likely, lawyers may be able to rely on overseas activities as a sort of hedge against instability at home. Access to overseas legal markets, then, remains an issue of high priority

Damage to left frontal regulatory circuits produces greater positive emotional reactivity in frontotemporal dementia.

Positive emotions foster social relationships and motivate thought and action. Dysregulation of positive emotion may give rise to debilitating clinical symptomatology such as mania, risk-taking, and disinhibition. Neuroanatomically, there is extensive evidence that the left hemisphere of the brain, and the left frontal lobe in particular, plays an important role in positive emotion generation. Although prior studies have found that left frontal injury decreases positive emotion, it is not clear whether selective damage to left frontal emotion regulatory systems can actually increase positive emotion. We measured happiness reactivity in 96 patients with frontotemporal dementia (FTD), a neurodegenerative disease that targets emotion-relevant neural systems and causes alterations in positive emotion (i.e., euphoria and jocularity), and in 34 healthy controls. Participants watched a film clip designed to elicit happiness and a comparison film clip designed to elicit sadness while their facial behavior, physiological reactivity, and self-reported emotional experience were monitored. Whole-brain voxel-based morphometry (VBM) analyses revealed that atrophy in predominantly left hemisphere fronto-striatal emotion regulation systems including left ventrolateral prefrontal cortex, orbitofrontal cortex, anterior insula, and striatum was associated with greater happiness facial behavior during the film (pFWE < .05). Atrophy in left anterior insula and bilateral frontopolar cortex was also associated with higher cardiovascular reactivity (i.e., heart rate and blood pressure) but not self-reported positive emotional experience during the happy film (p < .005, uncorrected). No regions emerged as being associated with greater sadness reactivity, which suggests that left-lateralized fronto-striatal atrophy is selectively associated with happiness dysregulation. Whereas previous models have proposed that left frontal injury decreases positive emotional responding, we argue that selective disruption of left hemisphere emotion regulating systems can impair the ability to suppress positive emotions such as happiness

Transcriptional Control of Adipose Lipid Handling by IRF4

SummaryAdipocytes store triglyceride during periods of nutritional affluence and release free fatty acids during fasting through coordinated cycles of lipogenesis and lipolysis. While much is known about the acute regulation of these processes during fasting and feeding, less is understood about the transcriptional basis by which adipocytes control lipid handling. Here, we show that interferon regulatory factor 4 (IRF4) is a critical determinant of the transcriptional response to nutrient availability in adipocytes. Fasting induces IRF4 in an insulin- and FoxO1-dependent manner. IRF4 is required for lipolysis, at least in part due to direct effects on the expression of adipocyte triglyceride lipase and hormone-sensitive lipase. Conversely, reduction of IRF4 enhances lipid synthesis. Mice lacking adipocyte IRF4 exhibit increased adiposity and deficient lipolysis. These studies establish a link between IRF4 and the disposition of calories in adipose tissue, with consequences for systemic metabolic homeostasis

Malaria chemoprophylaxis and the serologic response to measles and diphtheria-tetanus-whole-cell pertussis vaccines

BACKGROUND: Acute malaria has been associated with a decreased antibody response to tetanus and diphtheria toxoids, meningococcal, salmonella, and Hib vaccines. Interest in giving malaria drug therapy and prevention at the time of childhood immunizations has increased greatly following recent trials of intermittent preventive therapy during infancy (IPTi), stimulating this re-analysis of unpublished data. The effect of malaria chemoprophylaxis on vaccine response was studied following administration of measles vaccines and diphtheria-tetanus-whole cell pertussis (DTP) vaccines. METHODS: In 1975, six villages divided into two groups of children ≤74 months of age from Burkina Faso, were assigned to receive amodiaquine hydrochloride chemoprophylaxis (CH+) every two weeks for seven months or no chemoprophylaxis (CH-). After five months, children in each group received either one dose of measles or two doses of DTP vaccines. RESULTS: For recipients of the measles vaccine, the seroconversion rates in CH+ and CH- children, respectively, were 93% and 96% (P > 0.05). The seroresponse rates in CH+ and CH- children respectively, were 73% and 86% for diphtheria (P > 0.05) and 77% and 91% for tetanus toxoid (P > 0.05). In a subset analysis, in which only children who strictly adhered to chemoprophylaxis criteria were included, there were, likewise, no significant differences in seroconversion or seroresponse for measles, diphtheria, or tetanus vaccines (P > 0.05). While analysis for pertussis showed a 43% (CH+) and 67% (CH-) response (P < 0.05), analyses using logistic regression to control for sex, age, chemoprophylaxis, weight-for-height Z-score, and pre-vaccination geometric mean titer (GMT), demonstrated that chemoprophylaxis was not associated with a significantly different conversion rate following DTP and measles vaccines. Seven months of chemoprophylaxis decreased significantly the malaria IFA and ELISA GMTs in the CH+ group. CONCLUSION: Malaria chemoprophylaxis prior to vaccination in malaria endemic settings did not improve or impair immunogenicity of DTP and measles vaccines. This is the first human study to look at the association between malaria chemoprophylaxis and the serologic response to whole-cell pertussis vaccine