Idiopathic right atrial enlargement

A 26-year-old man presented with lower extremity edema and abdominal protrusion associated with dyspnea for 5 years, which had increased 7 months earlier. Echocardiography demonstrated a huge right atrium of 19.5 × 15.2 cm with a thick smoke pattern and severe tricuspid regurgitation. Magnetic resonance imaging confirmed intact pericardium. A pulmonary perfusion scan demonstrated multiple perfusion defects, suggesting recurrent small pulmonary emboli. Idiopathic enlargement of the right atrium was diagnosed. The patient declined surgery.

A retrospective comparative study on clinico-pathologic features of oral lichen planus and oral lichenoid lesions

Introduction:

Oral Lichen Planus (OLP) and Oral Lichenoid Lesions (OLLs) are clinically and histopathologically similar lesions but with different etiologies and treatment plan, thus differentiating these two has been the center of many researches. Studies in different populations have been performed on clinical and histopathologic features of OLP and OLLs. Thus aim of the present study was to evaluate and also compare the clinical and histopathologic features of these two diseases in a 10-year period in Esfahan.

Materials and Methods:

This descriptive–analytic study was based on retrospective survey of 232 records with clinical and histopathologic diagnosis of OLP and OLLs available from archive of oral pathology, Esfahan dental school 2000-2010. Data was statistically analyzed by use of independent t-test, Fisher exact, and Chi-square.

Results:

Involvement of lip was the only clinically significant difference between OLP and OLLs, most seen in OLLs. Band-like inflammatory infiltrate mainly composed of lymphocyte, saw toothed rete ridges, Max Joseph space, and atrophic epithelium was significantly seen in OLP. While hyperkeratosis, deep connective tissue infiltrate composed of eosinophil, neutrophil, and plasma cell were seen in OLLs.

Conclusion:

Involvement of lip was the only clinically significant difference between OLP and OLLs. Histopathologically strict band like infiltration, atrophic epithelium, saw toothed rete ridges, and Max Joseph space are reliable criteria for differentiation of OLP as deep connective tissue infiltration and hyperparakeratosis are for diagnosis of OLLs.

Odanacatib in postmenopausal women with low bone mineral density: a review of current clinical evidence

Human bones are in a continuous process of remodeling that ensures renovation and maintenance of the skeletal mass. Bone remodeling has two phases that are normally coupled and balanced: bone resorption mediated by osteoclasts and bone formation mediated by osteoblasts. An increase in bone resorption over bone formation results in a progressive loss of bone mass and impairment of bone microarchitecture leading to osteoporosis and its associated fractures. Recent advances in the understanding of the molecular and cellular mechanisms involved in the remodeling process have allowed the development of new targets for osteoporosis treatment. Cathepsin K, a cysteine protease, is found in osteoclasts along the bone resorption surfaces and very efficiently degrades type I collagen, the major component of the organic bone matrix. Inhibition of cathepsin K reduces bone resorption but does not impair bone formation particularly at cortical sites. Odanacatib, a potent and highly selective cathepsin K inhibitor, showed prevention of bone loss without reduction of bone formation in preclinical and clinical trials (phase I and II). Odanacatib is currently in a phase III fracture outcome international trial for the treatment of postmenopausal osteoporosis.

Prognostic factors after complete resection of pN2 non-small cell lung cancer

OBJECTIVES

This retrospective, multicenter study aimed to determine prognostic factors of completely resected pathologic N2 stage IIIA non-small cell cancer (NSCLC).

METHODS

From 25 participating hospitals, 496 patients (325 men and 171 women; median age, 65 years) who underwent complete resection without preoperative treatment for pT1-3 N2 M0, stage IIIA NSCLC between 2000 and 2004 were enrolled. Lobectomy/bilobectomy was performed in 462 patients and pneumonectomy in 34. Some kind of adjuvant chemotherapy was administered to 296 patients. Survivals were calculated using the Kaplan-Meier method, and prognostic factors were determined using the Cox proportional hazards model.

RESULTS

Five-year overall survival (OS) and disease-free survival (DFS) were 44.8% and 24.2%, respectively. pT classification (hazard ratio (HR), pT1/pT2/pT3 = 1/1.32/2.03), single or multiple N2 metastases (HR, single/multiple = 1/1.36), and skip or nonskip N2 metastasis (HR, skip/nonskip = 1/1.30) were found to be independent prognostic factors for DFS. Sex (HR, female/male = 1/1.36), performance status (HR, PS-0/PS-1 = 1/1.37), tumor diameter (HR, 1.12 per 1-cm increase), pT-factor (HR, pT1/pT2/pT3 = 1/1.37/2.22), and extent of N2 metastasis (HR, localized/extended = 1/1.39) were shown to be independent prognostic factors for OS.

CONCLUSIONS

We found that pT classification was a significant prognostic indicator for OS and DFS whereas tumor diameter, performance status, and sex were ones for OS. Single N2 metastasis and skip N2 metastasis were demonstrated as favorable prognostic factors for DFS, limited N2 metastasis was one for OS, and these should be considered as stratification factors for trial on adjuvant therapy.

A case of pathologic splenic rupture as the initial manifestation of acute myeloid leukemia M2

A pathologic splenic rupture refers to a rupture without trauma. A splenic rupture as the initial manifestation of acute myeloid leukemia is extremely rare. In this study, we described a rare case of acute myeloid leukemia presenting principally as an acute abdomen due to a pathologic splenic rupture in a 35-year old male patient. We can assert that a pathologic splenic rupture in hematologic diseases is a potentially life-threatening complication, which necessitates immediate operative intervention. Any such patient complaining about left upper abdominal tenderness should be closely observed, and further diagnostic investigations (ultrasonograph of the abdomen, abdominal CT scan) should be initiated in order to rule out a splenic rupture. The oncologist should be aware of this rare initial presentation of acute myeloid leukemia (AML) M2, as the condition generally necessitates a prompt splenectomy.