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Subcapital fractures of the femoral neck: prevalence and cause of radiographic appearance simulating pathologic fracture.

OBJECTIVE: Subcapital fractures of the femoral neck are common in elderly persons who have osteoporosis. Occasionally, radiographs of the hip in these patients show a radiolucency in the superolateral, subcapital region of the femoral neck that mimics the features of a pathologic fracture. Our purpose was to determine the prevalence of this finding and the anatomic variations of fracture alignment that cause this appearance. MATERIALS AND METHODS: All subcapital nonpathologic hip fractures (n = 111) that occurred at our institution during a 5-year period were reviewed. Radiographs were available in 100 of these cases. Review of intraoperative biopsy specimens, available in 69 patients, revealed no evidence of neoplasm in any case. In the other patients, follow-up radiographs, clinical evaluation, and pathology reports were used to exclude neoplastic involvement. Preoperative radiographs were analyzed for the presence of findings suggesting a pathologic fracture. Fracture configuration was classified by using the Garden staging system. Cadaveric femurs (n = 6) were fractured and studied radiographically. RESULTS: Seventeen (17%) of the 100 subcapital fractures had a radiographic appearance similar to that of a pathologic fracture. This finding occurred only with Garden stage III fractures (n = 7, 32% of Garden stage III fractures) or Garden stage IV fractures (n = 10, 24% of Garden stage IV fractures). Study of the cadaveric femoral specimens showed that the radiographic appearance simulating a pathologic fracture was primarily caused by external rotation of the distal fracture fragment and was accentuated by displacement between fracture fragments. CONCLUSION: The radiographic appearance of subcapital fractures of the femoral neck unrelated to neoplasm is often similar to that of pathologic fractures. This appearance is caused primarily by rotation of the fracture fragments, and the finding is accentuated by displacement. Recognition of the appearance of subcapital hip fractures mimicking pathologic fractures and knowledge of the cause of this finding are important for prescribing appropriate treatment.

Adolescent↗

Impulse control disorders and attention deficit disorder in pathological gamblers.

Little systematic research has been done on psychiatric comorbidity of pathological gambling, an impulse control disorder. This report describes the occurrence of attention deficit disorder and impulse control disorders in 40 pathological gamblers in treatment for gambling problems and 64 controls. Diagnoses were made by structured interviews which utilized operationalized diagnostic criteria. An impulse control disorder other than pathological gambling was noted in 35% of the pathological gamblers, compared to 3% of the controls (p < .001). Compulsive buying (p < .001) and compulsive sexual behavior (p < .05) were significantly higher in pathological gamblers than controls. A strong association was seen among pathological gambling, attention deficit, and other impulse control disorders. Attention deficit disorder was seen in 20% of the pathological gamblers. Rates of impulse control disorders did not differ by gender. Implications of these high rates of comorbidity are discussed.

Adult↗

Surgical treatment of limbic epilepsy associated with extrahippocampal lesions: the problem of dual pathology.

The authors present their review of 178 patients who underwent en bloc temporal lobectomies as surgical treatment for intractable epilepsy. Hippocampal cell density was quantitatively analyzed and the histology of the anterior temporal lobe was reviewed. Fifty-four patients (30.3%) had evidence of extrahippocampal lesions in addition to neuronal cell loss within the hippocampus (the dual pathology group). The pattern of cell loss was analyzed in the remaining 124 cases (69.7%) with no extrahippocampal pathology, and compared with that of the dual pathology group and a control group of four nonepileptic patients. Hippocampal cell loss was found in almost all epileptic patients compared to the control group. Severe cell loss greater than 30% of control values was found in 88.7% of patients without extrahippocampal lesions, but in only 51.8% of patients with dual pathology. The difference between these two groups was statistically significant (p less than 0.001). In the dual pathology group, lesions of different pathology had a significant relationship with the degree of hippocampal cell loss: all 12 patients with glioma had mild cell loss, whereas all 13 patients with heterotopia were associated with severe cell loss. Severity of hippocampal cell loss was also analyzed in relation to seizure history: a prior severe head injury was associated with severe cell loss. Other factors such as seizure duration, secondary generalization, or family history of seizures were not associated with hippocampal damage. Dual pathology may produce a combination of neocortical and temporolimbic epilepsies that warrants a precise definition of the true epileptogenic area prior to surgical treatment.

Adolescent↗

Seizure outcome following standard temporal lobectomy: correlation with hippocampal neuron loss and extrahippocampal pathology.

The authors reviewed 149 patients who underwent standard anterior temporal lobectomies for intractable complex partial epilepsy with a mean follow-up period of 5 years. Quantitative analyses of hippocampal neuron loss showed that all patients had some cell loss compared to control hippocampi obtained at autopsy. The average hippocampal cell loss was categorized as severe (greater than 30% of autopsy control levels) or mild. Analysis of hippocampal and extrahippocampal pathologies showed that in 109 cases (73%, the hippocampal lesion group) hippocampal cell loss was mild in 17 cases (16%) and severe in 92 cases (84%); in the remaining 40 cases (27%, the extrahippocampal structural lesion group) hippocampal cell loss was mild in 24 cases (60%) and severe in 16 (40%). The first index of surgical outcome was worthwhile seizure reduction, which occurred in 94 cases (86%) with mild or severe hippocampal lesions and in 33 cases (82%) with extrahippocampal pathology. In the hippocampal lesion group, worthwhile seizure reduction occurred in 90% of cases with severe and in only 65% of cases with mild hippocampal cell loss (p = 0.015). In the extrahippocampal pathology group, worthwhile seizure was not statistically different, whether hippocampal cell loss was severe (94% of cases) or mild (75% of cases). The second index of surgical outcome was the occurrence of residual seizures in the patients with worthwhile seizure reduction, which would indicate remaining epileptogenic tissue. In the hippocampal lesion group, the incidence of residual seizures was not statistically different whether hippocampal cell loss was severe (24% of cases) or mild (45% of cases). However, in the extrahippocampal pathology group, residual seizures occurred in 53% of cases with severe cell loss (dual pathology) but in only 11% of cases with mild cell loss (p = 0.025). Worthwhile seizure reduction can be predicted by the presence of either severe hippocampal cell loss or an extrahippocampal structural lesion. However, residual seizures more frequently follow in cases with a combination of both (extrahippocampal pathology associated with severe hippocampal cell loss, or dual pathology), suggesting that epileptogenic tissue more likely extends outside the boundaries of a standard temporal lobectomy.

Adult↗

Gender differences in pathological gambling.

BACKGROUND: To determine the differences in clinical presentation, gambling behavior, and psychiatric comorbidity of male and female treatment-seeking pathological gamblers. METHOD: Sixty-nine consecutive individuals with DSM-IV pathological gambling (47 men and 22 women) applying to a specialized out-patient treatment program were evaluated with structured interviews, self-report questionnaires, and psychological scales. RESULTS: Sixty-seven percent of men (N = 26) versus 25% of women (N = 5) had been exposed to gambling in adolescence. Women had a later age at first bet and a faster evolution of the disorder. Female pathological gamblers were more likely to play bingo, whereas men tended to prefer slot machines. Male and female pathological gamblers had similar gambling severity and overall rates of psychiatric comorbidity. However, male pathological gamblers had higher rates of alcohol abuse/dependence and antisocial personality disorder, whereas women had higher rates of affective disorders and history of physical abuse. CONCLUSION: There are substantial gender differences in the clinical presentation and comorbidity of pathological gambling. These gender differences should be incorporated in the selection and planning of treatment for pathological gamblers.

Adult↗

Alzheimer pathology in elderly patients with glioblastoma multiforme.

CONTEXT: Alzheimer disease (AD) and glioblastoma multiforme (GBM) have similar peak, age-specific incidence rates; however, to my knowledge, only 1 case of GBM associated with AD has been reported to date. The frequency of AD pathology, including neuritic plaques, diffuse plaques, neurofibrillary tangles, and cerebral amyloid angiopathy in patients with GBM is unknown. Studies of cancer occurrence in patients with AD are contradictory, with frequencies reported as equal to and as less than that in the general population. The GBM/AD nonconcordance may reflect underreporting of AD pathology or other factors. OBJECTIVE: To compare the frequency and extent of neocortical AD pathology in autopsy cases involving patients aged 60 to 82 years, both with and without GBM. Design.-Case-control study. Setting.-Pathology department of a university hospital. PATIENTS: Thirty-six autopsy cases of GBM patients aged 60 to 82 years; 54 cases of patients in the same age group without GBM or other primary brain tumors. METHODS: Examination of tumor sections for GBM and of neocortical sections for AD pathology according to Consortium to Establish a Registry for Alzheimer Disease (CERAD) guidelines. RESULTS: Glioblastoma multiforme was confirmed in all tumor cases. Alzheimer disease pathology was present in 42% of cases with GBM and in 48% of cases without GBM; 28% of GBM cases had CERAD age-related plaque scores indicative or suggestive of AD; 43% of cases without GBM had CERAD age-related plaque scores indicative or suggestive of AD. CONCLUSIONS: Alzheimer disease pathology was underreported in both GBM and non-GBM patients. The influence of neurodegenerative processes on GBM symptoms and therapy in elderly patients requires further study.

Aged↗

[Relationship between clinical manifestation and pathology in pediatric renal diseases].

To elevate the clinical diagnosis and pathological compatibility of pediatric kidney diseases. Pathological changes from 101 cases of pediatric renal diseases were studied, covering 13 diseases entities, including glomerulo-nephritis, simple nephrotic syndrome, nephritic nephrotic syndrome etc. The technique of tru-cut biopsy under the guidance of B ultrasonogram was used in renal biopsy. The renal puncture biopsy was 100% satisfactory. Pathological changes involved 12 pathological types. MsPGN were the most commonly seen (39.6%), followed by MPGN and ICPGN (12.87% and 10.89%) respectively. It was found that children with similar clinical manifestation may possess different pathological changes, while the same pathological entity may present multiple clinical manifestation. The results suggest that renal biopsy pathological diagnosis is important in the diagnosis, treatment and prediction of prognosis in pediatric renal disease.

Adolescent↗

Comparison of endometrial pathologies collected by hysteroscopy and hysterectomy in postmenopausal breast cancer tamoxifen-treated patients.

PURPOSE OF INVESTIGATION: 1) To assess whether endometrial specimens obtained from removed uteri might show an increase in endometrial pathologies which had been previously diagnosed by hysteroscopy in postmenopausal breast cancer tamoxifen-treated patients. 2) To assess whether hysteroscopy is an efficient method of detecting endometrial pathologies in such patients. METHODS: The findings of two consecutive pathological evaluations in 18 postmenopausal breast cancer tamoxifen-treated patients, performed 11.2+/-11.2 months apart, were compared. The first specimen was collected by hysteroscopy and the second was obtained following hysterectomy. RESULTS: The most significant changes observed were three new cancers diagnosed at hysterectomy, one of which was poorly-differentiated. In the first (hysteroscopy) samplings, one patient had atrophic endometrium, a second patient had endometrial proliferation and a third patient had a benign endometrial polyp. Overall, 55.6% of the study patients had various endometrial pathologies in the first sampling, while 83.3% had endometrial pathologies in the second sampling. However, this difference was not statistically significant. CONCLUSION: 1) Endometrial histologic evaluations, performed on removed uteri 11.2+/-11.2 months following previous endometrial samplings of postmenopausal breast cancer tamoxifen-treated patients, showed a non-significant risk of developing overall endometrial pathologies. 2) Hysteroscopy may have missed some endometrial pathologies which were diagnosed later on in specimens obtained by hysterectomy.

Aged↗

[The relation between placental pathologic changes and serum nitric oxide levels of maternal and umbilical blood in intrauterine growth retardation].

OBJECTIVE: To study the relation between placental pathologic changes and levels of maternal and umbilical serum nitric oxide (NO) in intrauterine growth retardation (IUGR). METHODS: 38 patients with IUGR (IUGR group) and 30 healthy pregnant women in their late trimester (control group) were studied from Nov. 1997 to Oct. 1998. The placenta and the appendages of fetus were studied after delivery. The concentration of serum NO were determined with cortas' method. RESULTS: Placental pathological changes were found in 26 cases of IUGR group (68.42%), and the main pathological changes were growth retardation of villi and villositis. In the control group, 5 out of 30 cases had placental pathological findings (16.67%). There was statistically significant difference between the 2 groups (P < 0.01). In IUGR group, the maternal and umbilical NO concentration in the 26 cases with placental pathological changes decreased significantly when compared with that in 12 cases without obvious pathological findings of placenta (P < 0.05, P < 0.05); NO levels of umbilical cord were higher than that of maternal serum in both groups(P < 0.01, P < 0.05); There was correlation about serum NO concentration between mother and her fetus in both groups (r = 0.5475, r = 0.8506); but umbilical serum NO level was not related to the weight of the newborn (r = 0.2838). CONCLUSION: The obvious placental pathologic changes occurred in patient with IUGR caused noticeably lower NO levels in maternal and umbilical serum.

Adult↗

Prediction of prostate carcinoma stage by quantitative biopsy pathology.

BACKGROUND: Considerable evidence has shown that the use of computational algorithms to combine pretreatment clinical and pathology results can enhance predictions of patient outcome. The aim of this study was to prove that the application of such methods to predict patient-specific likelihoods of organ-confined (OC) prostate carcinoma (PCA) may be helpful to patients and physicians when they are choosing an optimal treatment for carcinoma of the prostate. METHODS: The authors used clinical and quantitative pathology results from the biopsy specimens of 817 PCA patients who had been evaluated at a large national pathology reference laboratory. The pathology parameters that were measured included the number of positive cores, Gleason grades and score, percentage of tumor involvement, and the tumor location. The pathologic stage of these cases, as determined by results from radical prostatectomy, lymphadenectomy, or bone scan, categorized the PCA as either OC, non-OC due to capsular penetration only (NOC-CP) or advanced disease with metastasis (NOC-Mets), i.e., seminal vesicle and/or lymph-node positive or bone-scan positive. There were a total of 481 OC cases, 185 NOC-CP cases, and 151 NOC-Mets cases. Patient-specific prediction models were trained by ordinal logistic regression (OLOGIT) and genetically engineered neural networks (GENNs), and the resulting trained models were validated by biopsy information from an independent set of 116 PCA patients. RESULTS: When the authors applied a cutoff of >or= 35% for the n = 817 training set of OC, NOC-CP, and NOC-Mets predictive probabilities, the OLOGIT model predicted OC PCA with an accuracy of 91%, whereas the GENN model predicted the same with an accuracy of 95%. When the authors employed the n = 116 validation set (76 OCs, 31 NOC-CPs, and 9 NOC-Mets), the OLOGIT and GENN models correctly identified OC PCA with 91% and 97% accuracy, respectively. CONCLUSIONS: The value of combining patient pretreatment diagnostic pathology parameters to make predictions concerning the postoperative extent of pathology was illustrated clearly in this study. This finding further confirms the need to pursue such approaches for PCA disease management in the future, especially with the increasing prevalence of clinical T1c (American Joint Committee on Cancer, 1977) disease.

Biopsy↗

[The relationships of PSA, FPSAR, clinical and pathological stage in patients with prostate cancer].

OBJECTIVES: To investigate the relationship between clinical and pathological stage, serum prostate specific antigen (PSA) concentration and free-to-total PSA ratio (FPSAR) in patients with prostate cancer. METHODS: Clinical and pathological stage were determined on the basis of pathological examination and clinic material in 42 prostate cancer patients treated by prostatectomy. PSA and FPSAR were measured before the operation. Spearman rank correlation was applied to evaluate the relationship between clinical and pathological stage, serum PSA concentration and FPSAR. RESULTS: Serum PSA concentration was significantly positively correlated with pathological stage(P < 0.05) but not correlated with clinical stage (P > 0.05) in prostate cancer patients. FPSAR was significantly correlated with pathological stage and negatively correlated with clinical stage in prostate cancer patients (P < 0.05). CONCLUSIONS: FPSAR is a more powerful predictor of clinical stage, pathological stage and prognosis than PSA.

Adult↗

[Hormonal therapy in oncologic treatment: pathogenic hypotheses and interactions between thyroid and breast pathologies].

INTRODUCTION: The aim to individuate the eventual correlation between the two pathologies has justified deeper studies to achieve new prospective approaches for both disease. BACKGROUND: We have selected 4 groups of patients who presented an association between the two pathologies: a) malignant breast pathology associated to a malignant thyroid pathology, b) patients with breast carcinoma who presented association with some thyroid alterations, c) patients with thyroid carcinoma who presented association with some breast alterations, d) patients who presented some associations between benign breast pathology and benign thyroid pathology. MATERIALS AND METHODS: We have excluded all patients with a clear physiological or surgical menopausal status, and we've so considered only patients with a regular menstrual cycle. We've so selected a group of 120 patients and we've performed in all these patients during the early follicular phase the following exams: breast echographic evaluation and thyroid echographic-structure and volume determination and finally hormonal determinations we have so obtained two breast subgroups: 32 patients with hyperestrogenic integrative hormonal characteristics, 28 patients subjected to adjuvant hormonal therapy with hypoestregenic hormonal status and finally two thyroid subgroups, 22 patients showing clinical or subclinical hypothyroidism, 38 patients showing clinical or subclinical hyperthyroidism. We've compared these data to a random age-matched health control women group of 25 patients. RESULTS: The first group of patient showed a thyroid hormonal pattern of subclinical hypothyroidism or at least free T3 and free T4 mean value currently under and TSH and TPO Ab levels curve currently over the mean values of the control group. The second group showed the TSH suppressed with free T3 and free T4 curves currently over the mean value of the control group. The third group showed slight elevations in serum PRL levels curve. The fourth group showed increased estrogen levels-curve, often over the mean value of the control group. CONCLUSION: How much is it allowed to perform an hormonal therapy, specially for a benign pathology if we're not yet able to understand the deep and unknown interaction between breast and thyroid?

Adult↗

Concentration of copper, iron, zinc, cadmium, lead, and nickel in bull and ram semen and relation to the occurrence of pathological spermatozoa.

In this study the concentration of copper, iron, zinc, cadmium, lead, and nickel in bull and ram semen and relation of these metals to spermatozoa morphology was investigated. Analysis by atomic absorption spectrophotometry showed that copper concentration was significantly higher (p<0.0001) in ram semen in comparison with bull semen. The zinc concentration was higher in bull semen in comparison with ram semen. The iron and cadmium concentrations in the semen were similar. Higher concentration of lead was found in ram semen. Higher levels of nickel were found in ram semen in comparison with bulls. In bull semen 11.79+/-4.88% of pathological spermatozoa was found. Higher occurrence of pathological spermatozoa was in ram semen (17.17+/-3.76) in comparison with the semen of bulls. Separated tail, tail torso, and knob twisted tail were the most frequent forms of pathological spermatozoa in both species. Correlation analysis in bulls showed high positive relation between iron and zinc (r = 0.72), nickel and separated tail (r = 0.76), separated tail and tail torso (r = 0.71), tail torso and total number of pathological spermatozoa (r=0.72), and between tail ball and total number of pathological spermatozoa (r = 0.78). In rams high positive correlation between cadmium and lead (r=0.98), nickel and separated tail (r=0.77), separated tail and total number of pathological spermatozoa (r=0.69), knob twisted tail and retention of cytoplasmic drop (r=0.78), and between knob twisted tail and other pathological spermatozoa (r = 0.71) was found. High negative correlation in ram semen was observed between copper and nickel (r=0.71), copper and separated tail (r=0.70), and between iron and tail torso (r=0.67). The results suggest that the studied metals have a direct effect on spermatozoa quality.

Animals↗

Olfactory tau pathology in Alzheimer disease and mild cognitive impairment.

OBJECTIVE: To examine the occurrence of tau pathology in the olfactory system in aged subjects and its relation to the severity of Alzheimer disease (AD) pathology. MATERIAL AND METHODS: 273 autopsy cases (167 female, 106 male, aged 61-102, mean 83.2+/-4.5 SD years) underwent a standard neuropathological assessment with immuno-histochemical study of tau and Abeta amyloid in the olfactory bulb and nerve, and diagnosis of AD using established consensus criteria including Braak staging of neuritic AD pathology. RESULTS: All cases of definite AD (Braak stages 5 and 6, n = 96) showed large numbers of neuropil threads and neurofibrillary tangles, with amyloid deposits in 50%, and neuritic plaques only in two cases. Braak stage 4 (n = 73) was associated with tau pathology in the olfactory system in 90.4 and amyloid deposits in 9%, Braak stage 3 (n = 56) with mainly mild to moderate olfactory tau lesions in 44.6 and Abeta deposits in 9%. Braak stage 2 (n = 22) showed olfactory tau pathology in 36.4% without amyloid deposits, whereas Braak stages 0 and 1 (n = 25) were all negative. Olfactory tau pathology showed highly significant correlation with neuritic Braak staging in the brain, while both scores showed significant but low correlation with age. CONCLUSIONS: These data confirm previous studies demonstrating considerable tau pathology in the olfactory system in all definite AD cases, in more than 2/3 of limbic AD and in more than 1/3 of elderly individuals with or without mild cognitive impairment associated with Braak stage 2. Clinical dementia correlated with both Braak and olfactory tau scores, indicating that both are associated with a high risk of cognitive decline.

Aged↗

Pathologic bone formation.

The literature on pathologic bone formation is reviewed first on the basis of clinical syndromes and second in relation to newer knowledge of the origin of the bone-forming cells and regulatory molecules. Pathologic bone formation can be categorized into three groups based on the initiating stimulus: trauma, tumors, and idiopathic causes. In the trauma category, the formation of ectopic bone is concerned with major and minor traumatic incidents, surgery, burns, and other causes. In the tumor category, direct and reactive pathologic bone formation is discussed with an emphasis on the different neoplasms capable of ectopic bone formation. The category of idiopathic causes involves the formation of pathologic bone following neurologic injury and in systemic ossification disorders. The origin of the bone-forming cells in all forms of pathologic bone has not been unequivocally determined. However, there is evidence suggesting that these cells may arise from osteogenic stromal elements. Potent bone formation growth-regulating factors have been recently identified, and these molecules must also participate in the formation of pathologic bone. Increased understanding of the processes that control pathologic bone formation will lead to better methods of preventing and treating disorders of ossification.

Bone Marrow Cells↗

[Pathologic oocytes within the scope of in vitro fertilization].

Data of 67 patients, in whom 114 inseminated oocytes with morphological abnormalities were registered by means of light microscopy, were compared with those of a control group consisting of 69 patients where in vitro fertilization (IVF) proved successful. Significant correlations were found between certain parameters of the IVF attempt and the appearance of the described pathological changes in the oocytes. A significantly higher incidence of oocyte pathology was found with elevated progesterone and also LH values during the follicular phase. With a great number of follicles and in the case of small-sized follicles there were significantly more pathological ova--both degenerated and pathologically fertilized. A good oestrogen increase after ovulation induction with human chorionic gonadotrophin (HCG) was associated with fewer morphological abnormalities of the inseminated oocytes. When spermatozoa with lower total motility (less than or equal to 40%) or an increased percentage of pathological forms (greater than 60%) were used for IVF, significantly more pathological oocytes appeared. A pathological spermiogram was noticeably correlated with an increased occurrence of a solitary decayed nuclear structure of the mature ovum. The significance of these connections and a hypothesis of the development of the described nuclear structure are discussed.

Adult↗

Current aspects of gynecological pathology in postmenopause.

Between 1982 and 1984 330 women in postmenopause for at least one year were admitted to the First Clinic of Obstetrics and Gynecology, Catania University Medical School, Catania, Italy, with a frequency of 10.04% of gynecological admissions. The most frequent pathologies were metrorrhagia (32.72%; 108 cases) from an atrophic endometrium or glandular hyperplasia of the endometrium, vaginoperineal lacerations with cystorectocoele with or without urinary incontinence (10.90%; 36 cases), cancer (11.21%; 37 cases) and ovarian cystoma (11.21%; 37 cases), uterine prolapse (9.30%; 31 cases), and endometrial polyps (9.09%; 30 cases). Uterine fibromyoma (3.93%; 13 cases) and carcinoma of the portio (3.93%; 13 cases) were among the rare pathologies. Uterine pathologies were the most prevalent (68.78%; 227 cases), followed by ovarian (15.15%; 50 cases), pathology of involving the pelvic and perineal containment (10.90%; 36 cases), vulvar pathology (2.72%; 6 cases), and vaginal pathology (1.51%; 5 cases). Malignant neoplastic pathology was reported in 25.45% of cases (84 cases) consisting only of uterine cancer (47.61%; 40 cases) and ovarian cancer (45.23%; 38 cases). In comparison with the study performed by Cetroni in 1952 one notes a net reduction in the frequency of uterine prolapse (by about three times), and a smaller reduction in cancer of the uterine cervix with a slight increase in cervical polyps, endometrial cancer, and above all in metrorrhagia from atrophic endometrium or glandular hyperplasia of the endometrium.

Adult↗

[Clinico-pathological study of preoperative chemotherapy of esophageal cancer by combined use of three drugs--cisplatin, 5-FU and leucovorin].

We compared the clinical and pathological effects of preoperative combination chemotherapy using CDDP, 5-FU, and response rate for the primary lesion, an 81.8% response rate for intramural metastasis, 100.0% for intraepitherial spread, and a low response rate of 40.7% for lymph node metastasis. Pathological examination showed a 55.2% response rate for the primary lesion. There were seven cases in which the clinical assessment indicated that treatment was effective and pathological examination showed that it was ineffective, and three cases in which pathological examination showed a better response than clinical assessment. Cases showing a better clinical response included in which necrotic cancer lesion had disappeared due to absorption by the time of pathological examination, those with tumor regrowth after preoperative evaluation, those evaluated as showing a poor response due to residual cancer at the margin. Cases showing a better pathological response included those having remaining necrotic tissues and those having myoma beneath tumor. For intramural metastatic lesions, the pathological response rate was 42.9%, being lower than the clinical response rate. Metastasis to 209 lymph nodes showed a 23.0% response rate, with the abdominal nodes showing a poor response in comparison with those of the cervix and mediastinum. In 26 patients receiving preoperative radiotherapy, there was a significantly higher frequency of such changes as fibrous scar tissue, foreign body giant cells, vacuolation of tumor cells, and hyaloid degeneration of the lesion in comparison with the group receiving chemotherapy. Another difference was that the radiotherapy group showed a higher response of tumors with venous and lymphatic involvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗