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PubMed2005

Identity deception: not a crime for a stem cell.

Stem cell transdifferentiation in the adult organism is the most common and questioned mechanism of growth and repair. Recent data suggest that adult stem cells are capable of generating mature cells beyond their own tissue boundaries, a process called developmental plasticity. To date, the most versatile cell discovered is the bone marrow progenitor cell.

Animals↗
PubMed1989

Complement and infectious agents: a tale of disguise and deception.

The primary functions of the immune system center on the recognition and elimination of infectious agents, foreign substances, and altered or transformed host cells. Bacterial and viral infections represent major challenges to the immune system because of the ability of these agents to replicate and injure host cells and tissues, and to impair recognition and elude destruction by humoral or cellular defense mechanisms. Complement functions at multiple levels in the control of bacterial infections: recognition, in vivo clearance, opsonization, killing and lytic destruction. Although bacteria frequently evade destruction and cause disease, the ultimate control of bacterial infections is largely dependent on the actions of antibody and complement functioning synergistically with phagocytic cells. The crucial role of complement in these actions is apparent in the striking susceptibility to life-threatening bacterial infections of most individuals who are genetically deficient in complement components, particularly C3, C3 regulatory proteins and C5, C6, C7 or C8. The complement system also interacts with viruses and virus-infected cells at multiple levels and, as in the case of bacteria, viruses have evolved various mechanisms to avoid destruction. As obligate intracellular parasites which reside in host cells; however, the elimination of viruses is largely dependent on cellular immune responses. Complement also interacts with parasites and fungi; however, the physiologic importance of these reactions has yet to be elucidated. The various types of interactions of infectious agents with the complement system and the mechanisms which these pathogens have evolved to evade destruction and, in some cases, to potentiate and facilitate infection are summarized here.

Bacterial Infections↗
PubMed1975

The deceptive aortic root.

Coronal, horizontal, and sagittal sections through the mid-line are excellent ways of depicting the anatomical position of the aortic root and for studying its topographical relationship to the surrounding vascular structures. Minimal radiographic abnormalities or no abnormalities at all may be present with an enlarged ascending portion of the thoracic aorta. Thus, frontal chest roentgenograms obtained with high kilovoltage, fluoroscopy and left anterior oblique projections should be utilized routinely for the evaluation of the ascending aorta. Calcification of the aortic valve and of the coronary arteries and the study of aortic valve prosthesis also demand a dynamic study and the use of complementary views, such as lateral and both oblique projections.

Aorta, Thoracic↗
PubMed2005

COX-2 inhibitors: a story of greed, deception and death.

In 1999, drug manufacturers introduced a class of NSAIDs called COX-2 inhibitors or coxibs. The drugs were avidly promoted directly to the consumers and became bestsellers from the start. Arthritis sufferers were eager to take medications that eased joint pain with less risk of causing gastrointestinal pain, bleeding and other side-effects. In the year after their introduction, doctors wrote over 100 million prescriptions for celecoxib (Celebrex) and rofecoxib (Vioxx). Celebrex is the sixth best-selling drug, with sales of more than US$ 4 billion since its debut in 1999. Vioxx had sales of US$ 2.6 billion in 2001. However, the coxibs increase the risk of heart attacks and strokes, and their price, in the USA, is obscene. The manufacturers faced a possibly complicit, toothless and bloodless FDA, and used every maneuvering to fleece the patients. We must now reflect on attitudes that we thought only belong to the tobacco industry. Fortunately, safe and active alternatives exist.

Acetaminophen↗
PubMed2005

Primary alveolar soft part sarcoma (ASPS) of the breast: report of a deceptive case with xanthomatous features confirmed by TFE3 immunohistochemistry and electron microscopy.

Alveolar soft part sarcoma (ASPS) is a rare neoplasm that most commonly presents in the lower extremities. Although ASPS has distinctive histologic features, it may cause diagnostic problems when it arises in unusual locations. To our knowledge, only 1 case of ASPS arising within the breast has previously been reported. Here, we report a second case of primary mammary ASPS. The patient was a 44-year-old woman who presented with a breast mass. Needle biopsy was performed, yielding a polygonal cell lesion with abundant, predominantly xanthomatous cytoplasm. The cells labeled strongly for the histiocytic marker CD68, suggesting a benign macrophage-rich lesion. However, the unusual nature of the lesion as well as the prominence of nucleoli prompted suggestion for an excision. The excision more clearly revealed the lesion's alveolar architecture and demonstrated cells with more eosinophilic cytoplasm, along with the xanthomatous cells. The diagnosis of ASPS was confirmed by electron microscopy, which revealed characteristic membrane-bound rhomboidal crystals, as well as by nuclear labeling for TFE3 protein by immunohistochemistry. With this report, we confirm the utility of a novel immunohistochmical technique for the identification of an ASPS presenting in an unusual locale.

Adult↗
PubMed2005

Varieties of deception and distrust: moral dilemmas in the ethnography of psychiatry.

This article considers the ethical guidelines concerning autonomy, negotiated consent and transparency in relation to an ethnography of psychiatry. It suggests that the complexities and unequal power distribution of the psychiatric consultation make these guidelines difficult to apply. Rather an attempt is made to develop an ethics of patient acknowledgement even where this presents ethical misgivings vis-à-vis psychiatrists. I argue for the importance of ethnography rather than the instantiation of abstract principles to the development of an ethical perspective.

Adult↗
PubMed2004

Assessing residual neuromuscular blockade using acceleromyography can be deceptive in postoperative awake patients.

UNLABELLED: Postoperative awake patients may have significant residual neuromuscular block. In awake patients, the results of accelerometry are affected by extra movements to which the thumb may be subject. In this study, we evaluated the repeatability of train-of-four (TOF) ratio using acceleromyography in 253 patients recovering from anesthesia. Immediately after arrival in the postanesthesia care unit, the ulnar nerve was stimulated with TOF stimulation. The evoked response at the thumb was measured by the TOF-Watch apparatus. The current intensity was 30 mA. Two TOF stimulations were applied and recorded at 30-s intervals. A Bland-Altman test was used. The Kappa (kappa) test for clinical agreement between the two measurements was also calculated according to the presence or absence of a residual neuromuscular blockade, defined as a TOF ratio <0.9. According to the presence of a residual neuromuscular blockade, the paired TOF ratios were discordant in 61 patients (24%; 95% confidence interval, 21%-27%). The kappa test indicated a moderate agreement (k = 0.47). We demonstrated that accelerometry as used in this study is not always accurate. Two isolated acceleromyograph TOF ratios are not an accurate representation of the neuromuscular status of the patient recovering from anesthesia. IMPLICATIONS: Clinicians should be aware that acceleromyography as used in this study does not always provide precise train-of-four ratio measurements. Two isolated acceleromyograph train-of-four ratios are not an accurate representation of the neuromuscular status of the patient recovering from anesthesia.

Adult↗