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PubMed1991

Diagnosis of salivary gland tumors by fine-needle aspiration cytology: a review of clinical utility and pitfalls.

Fine-needle aspiration cytology has become a frequently used technique for the diagnosis of neoplasms of the head and neck. While the method has a high sensitivity and specificity for the diagnosis of salivary gland lesions, important pitfalls for the cytologic diagnosis of these lesions exist. This paper discusses the diagnostic pitfalls and investigates strategies for the evaluation of salivary gland masses.

Biopsy, Needle↗
PubMed1998

Reviewing the potential utility of interleukin-7 as a promoter of thymopoiesis and immune recovery.

The identification of interleukin-7 (IL-7) as a critical cytokine in early B- and T-cell development, combined with the discovery that it acts on mature T cells, opens new avenues for investigating the thymopoietic machinery and manipulation of the immune system. Initially, IL-7 was thought to be a growth factor in the context of the B-cell lineage in that it stimulates proliferation of early B-cell progenitors. However, it appears that this cytokine has a much broader field of activity within the network of signal transduction. Indeed, evidence exists to support the pivotal involvement of IL-7 in the gene rearrangement of the T-cell receptor repertoire that ultimately leads to thymocyte commitment. The finding that IL-7 is an inducer of both cytotoxic T-cell- and lymphocyte-activated killer cells is one of the significant recent developments in the field of tumor immunology. Lately, it has been demonstrated that administration of IL-7 to mice after myeloablative treatment accelerates immune recovery via a unique pathway. This review of the literature dealing with IL-7 in the realm of immune function shows, inter alia, the value of the cytokine in immunosuppressed animals. The collection of findings noted in this paper may be considered the forerunner for clinical application of IL-7 in a variety of conditions of hematolymphopoietic failure.

Animals↗
PubMed1994

Cardiac contusion and creatine kinase-MB: a pertinent case history and brief review of the utility of CK-MB.

Cardiac contusion is defined as the myocardial cellular damage that can result from nonpenetrating chest trauma. However the noninvasive diagnosis of this lesion is problematic. Among the criteria suggested for the diagnosis of cardiac contusion is an elevation of serum levels of the heart-specific isoform of the enzyme creatine kinase (CK-MB). We present here the case of a patient who, on the basis of an initial elevation of CK-MB, was suspected of having cardiac contusion as a result of a motor vehicle accident. The patient was clinically stable and there were no other signs to support this diagnosis. Serial analyses showed a fall in total CK to below the upper limit of the reference interval but, as a percent of total activity, CK-MB was constantly slightly elevated (values 5.1-6.5%, upper limit of normal = 4%). At the same time the patient appeared to be improving clinically. The patient's status deteriorated suddenly and he eventually went to surgery where a large intramural haematoma and a left ventricular aneurysm were discovered. The significance of the elevations of serum CK-MB is discussed and a brief review of the literature is presented.

Biomarkers↗
PubMed1993

Clinical review 46: Clinical utility of inhibin measurements.

New and specific assays, probably based on two-site assay technology, for various forms of circulating gonadal peptides are likely to be available within the next few years and these in turn should open up a range of potential clinical applications, particularly in andrology, management of ovulatory disorders, and especially ovarian and perhaps other malignancies. Current inhibin assays are already proving to be of great value in ovarian cancer management. The recent demonstration that inhibin subunits and dimeric activin are present in the human adrenal also raises the possibility that measurement of inhibin and activin may ultimately be applicable to the study of adrenal disorders.

Activins↗
PubMed2006

Osteogenic protein-1 : a review of its utility in spinal applications.

The potentially revolutionary effect that bone morphogenic proteins (BMPs) could have on orthopaedic surgery has fueled an exhaustive research effort that continues today. Upwards of 1.5 million bone-grafting operations take place in the US annually, with the anterior and posterior iliac crest being the most common donor site for autologous bone graft. Harvesting autologous bone graft, however, is not benign. It is postulated that a synthetic bone graft containing BMPs would possess the characteristics of autologous bone that allow new bone formation: osteogenesis, osteoinduction, and osteoconduction, without the negative repercussions related to bone harvesting. As a result of the ensuing research following their discovery some 40 years ago by Marshall Urist, the basic science behind BMPs has been largely uncovered. New information on BMPs now comes from clinical trials regarding their utility and efficacy in surgical applications. To date, BMPs have been studied in skeletal bone surgery throughout the body, and have been found to be particularly useful in surgical applications such as spinal arthrodesis. Osteogenic protein-1 (OP-1), or recombinant human BMP-7, is one subtype of BMPs that has shown particular potential in clinical trials. Pre-clinical and clinical studies have, thus far, garnered OP-1 a Humanitarian Device Exemption approval for spinal applications in the US. As clinical trials with larger patient numbers and longer clinical follow-up are completed, the usefulness of OP-1 as a bone graft substitute will be better elucidated.

Animals↗
PubMed2006

Animal models for the study of squamous cell carcinoma of the upper aerodigestive tract: a historical perspective with review of their utility and limitations. Part A. Chemically-induced de novo cancer, syngeneic animal models of HNSCC, animal models of transplanted xenogeneic human tumors.

Understanding the complex histological, genetic and molecular changes that lead to malignant transformation of squamous epithelia of the head and neck will likely guide the development of methods for improved diagnosis, monitoring and treatment of head and neck squamous cell carcinoma (HNSCC). The development and use of animal models that closely mimic the histopathology and molecular pathogenesis of HNSCC in humans would greatly expand the research possibilities and provide a means of testing potential therapeutic agents. However, many available animal models of HNSCC fall short of this objective. In order for investigators to select the appropriate model to answer scientific questions, it is important to understand the benefits and limitations of available animal models for the study of HNSCC. The purpose of this work is to give an overview of the most pertinent animal models of HNSCC, and to discuss future directions of research in this field.

Animals↗
PubMed2000

MOC31 immunoreactivity in primary and metastatic carcinoma of the liver. Report of findings and review of other utilized markers.

Differentiating between primary tumors of the liver and metastatic lesions can, at times, be difficult. Various histochemical and immunohistochemical methods have been used in an effort to better delineate between hepatocellular carcinoma (HCC), especially the microglandular variant, primary cholangiocarcinoma, and metastatic adenocarcinoma; these ancillary studies can yield less than satisfactory results. Recently, anti-MOC31, a monoclonal antibody directed against a cell surface glycoprotein, has been shown to be helpful in distinguishing between adenocarcinoma and mesothelioma. This study addresses whether this antibody might be helpful in distinguishing between HCC, primary cholangiocarcinoma, and metastatic adenocarcinoma in the liver. Formalin-fixed, paraffin-embedded tissue sections from 15 HCC (including 10 microglandular variants), 14 primary cholangiocarcinomas, and 33 metastatic adenocarcinomas (7 colon, 1 lung, 8 breast, 4 GE jct/gastric, 9 pancreas, 2 small intestine, 1 renal, 1 ovary) were immunostained with anti-MOC 31 (1:40, Dako) after protease digestion and biotin block using a modified ABC technique. Positive staining was limited to membrane based reactivity; controls stained appropriately. Immunoreactivity for MOC31 was observed in 14 of 14 cholangiocarcinomas and 33 of 33 metastatic tumors. Staining was diffuse, intense, and readily interpretable, with rare exceptions. All 15 cases of HCC were negative. We conclude that cholangiocarcinoma and metastatic adenocarcinoma from a variety of sites express MOC31; HCC is uniformly negative for this marker. Anti-MOC31 may prove useful in the evaluation of liver neoplasms where primary hepatocellular and adenocarcinoma enter the differential diagnosis; it is not useful in separating primary cholangiocarcinoma from metastatic adenocarcinoma.

Adenocarcinoma↗
PubMed1992

Quantitative and qualitative coronary angiographic analysis: review of methods, utility, and limitations.

Coronary angiography continues to be the pivotal study in the diagnosis and treatment of ischemic cardiac disease. Although angiographic equipment and imaging techniques have advanced over the past three decades, the analysis of coronary angiograms, by visual estimated percent diameter stenosis, has remained unchanged in most clinical catheterization laboratories. Rapid, computerized angiographic analysis systems are now available that remedy the inherent imprecision and inaccuracies plaguing visual coronary analysis. Despite its advantages, successful QCA is quite dependent on meticulous attention to radiographic and angiographic technique, even more so than with visual analysis. Although the available QCA systems can reproducibly and accurately define the site and degree of coronary stenosis, they cannot routinely determine whether an obstruction is flow limiting. Several methods, some based on extrapolations of quantitative measures alone, and others based on digital subtraction angiography, have been developed to determine the physiologic impact of a given coronary lesion. Recent observations have demonstrated, however, that even if the physiologic consequences of an obstruction are known, the prognosis of the lesion over time cannot be predicted. The qualitative, morphologic characteristics of a lesion are as, or more, important than the quantitative lesion attributes in determining an atheroma's behavior and stability, and hence, qualitative descriptors should be incorporated into QCA analyses. Although not currently available, future QCA systems will provide, by automated analysis, reproducible and accurate measures of absolute obstruction, physiologic data describing the flow limiting characteristics of a lesion, and qualitative, morphologic lesion descriptors. Implementation of these systems should provide more consistent and accurate prognostic and pathophysiologic information, thereby helping to refine and more effectively direct therapeutic interventions in coronary artery disease.

Algorithms↗
PubMed2001

A case of adenoid cystic carcinoma (ACC) of the breast and review of the utility of preoperative imaging diagnose.

A case of adenoid cystic carcinoma (ACC) of the breast in a 66-year-old woman is reported herein. ACC accounts for about 0.1% of all breast cancers. Our patient presented with a small, elastic and hard mass, measuring 2.0x2.0 cm, between both outer quadrants of the right breast. Although physical examination, ultrasonography and magnetic resonance (MR) mammography suggested a benign tumor, aspiration biopsy cytology (ABC) was performed twice, and the second ABC specimen was evaluated as suspicious for breast carcinoma. Breast conserving surgery with a level II lymph node dissection was subsequently performed. There was no lymph node metastases and estrogen receptor (ER) status was negative. Light microscopy revealed various growth patterns, with the cells showing biphasic cellularity. According to immunohistochemical analyses, CEA, actin and vimentin were positive, S-100 protein was negative, and the cytokeratin reaction was partially positive. Therefore, ACC of the breast was diagnosed. Although ACC of the breast is a rare neoplasm, it should be considered in the differential diagnosis even if various diagnostic imaging studies suggest a benign tumor of the breast. Awareness of this tumor will help prevent misdiagnosis.

Actins↗
PubMed1996

Sumatriptan use in a large group-model health maintenance organization.

The outcomes of sumatriptan use at a health maintenance organization (HMO) were studied. The study was conducted during one year beginning immediately after sumatriptan was added to the formulary of a large group-model HMO. Subjects were included on the basis of drug-use evaluation criteria, a positive response to the first dose of sumatriptan (administered at the HMO by a nurse), and ability to participate in a telephone survey. Responders to the first dose were eligible to receive up to six doses of sumatriptan for home use. The telephone survey was designed to assess sumatriptan's effects on migraine headache and to capture data on quality of life, perceived problems with sumatriptan, and patient satisfaction. Patients who received sumatriptan between April and September 1993 were interviewed in late September 1993; patients who received sumatriptan between September and April 1994 were interviewed in late April 1994. Of 180 patients surveyed, 160 (89%) had evaluable responses. Migraine headache improved in two thirds of the patients. Sumatriptan was more effective than previously used agents in three fourths. The mean number of migraine headaches per patient per month decreased from 7.4 to 4.2. Quality-of-life indicators, such as time spent with friends, improved in three fourths. Eighty-three percent reported missing fewer days from work. Ninety percent said they would continue to take the drug, despite a 44% incidence of drug-related problems. There were no unexpected problems. A retrospective review showed that utilization of the HMO's resources was reduced with sumatriptan. Placing sumatriptan on an HMO's formulary led to favorable effects on the frequency and severity of migraine headache, patient quality-of-life indicators and productivity, and resource utilization by the organization.

Adolescent↗
PubMedDate not supplied

Design of RCSS: Resource Coordination Systems for Surgical Services using distributed communications.

The plans for Resource Coordination for Surgical Services system (RCSS) incorporate a distributed objectbase with a coordinating server. User-centered information screens are customized for each geographic location in surgical services. User interfaces are designed to mimic paper lists and worksheets used by health care providers. Patient-specific and site-specific data will be entered and maintained by providers at each geographic location, but also rebroadcast and displayed for all providers. Although RCSS is primarily a communications system, it will also support review of surgical utilization and operative scheduling.

Cost Control↗