A case of squamous cell carcinoma of the skin due to the molecularly confirmed Lynch Syndrome

Patients with Lynch Syndrome are at high risk for developing a variety of cancers including cancers of the colon or rectum, small bowel, stomach, uterus, renal pelvis, ureter, biliary tract, ovaries, brain and pancreas (N Engl J Med 348: 919-32, 2003; Gut 57:1097-101, 2008; NCCN, Inc Guideline. Ft. Washington, PA. Online Version 2.2014). Lack of MLH-1 and MSH-2 expression commonly result from germline mutations in this inherited cancer syndrome. Here, we report the case of a patient with a molecularly confirmed germline mutation in MLH-1 along with a colon cancer showing lack of expression of MLH-1 as well as a squamous cell cancer of the skin from the abdominal wall also demonstrating lack of expression of MLH-1. This case appears to represent the second case report of a squamous cell skin cancer apparently due to the Lynch Syndrome and further supports a proposed relationship between Lynch Syndrome and these tumors

Marked radiographic response of a HER-2-overexpressing biliary cancer to trastuzumab

Steven SorscherWashington University School of Medicine, Department of Oncology, St Louis, MO, USAAbstract: Trastuzumab is a monoclonal antibody targeting HER-2. HER-2 overexpression has been described in gallbladder cancer and in cholangiocarcinoma. This report describes the first case of a patient with HER-2 overexpressing metastatic gallbladder adenocarcinoma and responding radiographically and biochemically to trastuzumab alone.Keywords: metastatic gallbladder adenocarcinoma, HER-2 overexpression, trastuzuma

Papillary Renal Carcinoma Presenting as a Cancer of Unknown Primary (CUP) and Diagnosed through Gene Expression Profiling

Cancer of unknown primary (CUP) is a clinical syndrome representing many types of cancers and diagnoses are typically made after review of clinical presentation, pathology (including immunohistochemical staining) and imaging studies. Treatment with systemic chemotherapy has been shown to result in fairly reproducible objective response rates. Herein, a case of a patient who was initially diagnosed with a poorly differentiated adenocarcinoma of unknown origin is reported. After mRNA gene expression profiling (commercially available CancerTYPE ID), a specific diagnosis of papillary renal cell carcinoma (RCC) was made and then confirmed with additional immunohistochemical staining. The patient was treated with targeted therapy and an objective radiographic response was seen. A literature review suggests this to be the first patient with papillary RCC, identified by molecular profiling, and benefitting from a targeted agent that otherwise would not have been considered in the setting of CUP. This case underscores the importance of considering the use of newer testing technologies in the interest of offering patients more specific, targeted therapy in order to improve efficacy and spare patients toxicities of less specific, empiric chemotherapeutic regimens

Profiling of micrometer sized laser beams in restricted volumes

We present a method for determining the 3D intensity distribution of directed laser radiation with micrometer resolution in restricted volumes. Our method is based on in-coupling and guiding properties of optical fibers, with the current version requiring only few hundred micrometers. We characterize the performance of the method and experimentally demonstrate profiling of micrometer sized laser beams. We discuss the limiting factors and routes towards a further increase of the resolution and beam profiling in even more restricted volumes. Finally, as an application example, we present profiling of laser beams inside a micro ion trap with integrated optical fibers

Incest, Cannibalism, Filicide: Elements of the Thyestes Myth in Ovid's Stories of Tereus and Myrrha

This thesis analyzes key stories in Books 6–10 of Ovid’s Metamorphoses through a focus on the pair of stories that bookend the central section of the poem, the narratives of Tereus and Myrrha. These two stories exemplify the mythic types of the family-centered stories in Books 6–10: Tereus’ is a tale of filicide (specifically, filial cannibalism), while Myrrha’s features incest. Ovid links these stories through themes and plot elements that are shared with the tragedy of Thyestes, a paradigmatic tragic myth encompassing both filial cannibalism and incest, otherwise untold in the Metamorphoses. Through allusions to Thyestes’ myth, Ovid binds together the sequence of human dramas in the poem, beginning and ending with the Tereus and Myrrha stories. Furthermore, the poet reinforces and signals the connections between the stories through textual echoes, lexical formulations, and shared narrative elements.Master of Art

An Herbivorous Dinosaur Coprolite From The Lower Cretaceous Ruby Ranch Member of the Cedar Mountain Formation, Utah, USA: Organic Contents, Taphonomy, and Diagenesis

Coprolites from herbivorous dinosaurs, although rare, can be highly informative in our understanding of past ecosystems. They contain information about dinosaur diet, diagenetic conditions, and paleoenvironmental setting. Despite being useful for interpreting dinosaur diet, the fossilization processes of dinosaur coprolites are poorly understood and rarely studied. This analysis examines an herbivore coprolite from the Lower Cretaceous Cedar Mountain Formation, Utah. X-ray and neutron tomography were used to non-destructively image the organic contents of the specimen. Petrography was used to examine the mineralogy and diagenetic processes. The coprolite is dominated by leaf epidermis from two types of plants and is the first Mesozoic vertebrate herbivore coprolite to record such a homogenous and leafy diet. The plant material contains ample cuticle, and the adaxial layer of epidermal cells is often preserved. The specimen is pervasively mineralized with calcite and chalcedony and shows evidence of phreatic diagenesis. It is likely that this coprolite was preserved due to three main factors: the presence of refractory organic matter in the form of cuticle-rich leaf epidermis, surface waters supersaturated with silica and/or calcite, and a phreatic diagenetic regime. Studying the contents and mineralogy of herbivore coprolites not only provides information on diets and paleoecology but also offers clues to the taphonomic history of herbivore coprolites. This information may be useful in finding additional herbivore coprolites in formations with similar paleoenvironmental and diagenetic conditions.</p

Patient-predicted sleep position vs. HST data: a tendency to underestimate supine sleep

Purpose The purpose of this study is to measure people’s accuracy when they estimate what proportion of their nightly sleep at home is supine vs. non-supine. Methods A series of patients referred for obstructive sleep apnea (OSA) evaluation were asked if they Bknew with confidence^ how they slept with regard to their body position. BYes^ responders were then asked to estimate what percentage of their sleep was supine vs. non-supine. This value was compared with the actual proportion of supine vs. non-supine sleep that they exhibited in a home sleep test (HST) that followed. Results We obtained data from 49 subjects who expressed that they Bknew with confidence^ how they sleep in terms of body position. Subjects in aggregate underestimated their proportion of supine sleep by 21.6% (p \u3c .001). Thirty-nine subjects (80%) slept supine more in the HST whereas 8 (16%) slept supine less compared to their pre-test estimates. Using a common classification of OSA severity, 9 subjects (18%) demonstrated a more severe degree of OSA than would have occurred had they slept as they had predicted. Conclusions Subjects in this study frequently underestimated their proportion of supine sleep compared to values measured in an HST. Because of the increased supine sleep they exhibited, the severity of their OSAwas often greater in the test than it would have been had the subjects slept as they predicted

Pro filia, pro uxore: Young Women in the Conventional and Unconventional Families of Roman Comedy

In this dissertation, I explore both the diverse variability and the traditional ideologies of the Roman family in the powerfully relevant medium of Roman comedy, with a particular focus on how different types of families in the genre treat young women. Plautus and Terence reinvented their dramatic form to depict families that would be recognizable, meaningful, and resonant for their audiences in Rome and Italy of the 200s–160s BCE. These playwrights show an expanded definition of family beyond the familiar citizen form repeatedly presented in later evidence. Around the citizen families that are the focus of the genre, they stage families of choice created by marginalized people (lower-class women and foreign soldiers in particular).In Plautus’ and Terence’s plays, I identify two patterns: (1) a critique of the legal and social institutions that governed citizen family life in Rome of their day and (2) a counter-staging, as it were, of alternate models of families that contrast sharply with the citizen family in their structures, members, and priorities. Plautus and Terence critique the ideological vision of family relationships, with particular attention to the destructive effects of patria potestas on daughters, and they frequently stage non-legal or socially unacceptable chosen families that are oriented toward cherishing and protecting girls and young women.In Chapter One, I give background on the genre of New Comedy and on familial norms in Roman law and in Plautus’ and Terence’s plays. In Chapter Two, I analyze the harm that patria potestas and uncaring fathers can cause for citizen daughters in Plautus’ plays. In Chapter Three, I show that in contrast, in both Plautus and Terence’s plays, families led by lower-class women, often meretrices, protect and support the young girls in their care, even without biological kinship or the resources of citizen men. In Chapter Four, I identify a new form of relationship between foreign soldiers and the meretrices with whom they pursue marriage-like unions. I conclude with a discussion of the resonance and legimacy these depictions would have granted to members of such unconventional families in Plautus’ and Terence’s varied and stratified audiences.Doctor of Philosoph

Bilateral Luxatio Erecta Humeri With Acute Anterior-inferior Re-dislocation

Luxatio erecta is a description for a specific and rare type of shoulder dislocation where the humeral head dislocates directly inferior. This rare form of glenohumeral dislocation accounts for only 0.5% of shoulder dislocations. It is even less common for both shoulders to be bilaterally dislocated inferiorly with the characteristic “hands up” posture. A limited number of these bilateral occurrences are described in the literature to date and most have been from higher energy trauma. We have described a low energy case of bilateral luxatio erecta and the reduction method used and the continued instability following successful reduction under procedural anesthesia