247 Single-Photon Emission Computed Tomography (SPECT) In Predicting Localisation of Parathyroid Adenomas: A Closed-Loop Prospective Study

Aim

to measure the sensitivity of SPECT in localising parathyroid adenomas particularly whilst attempting minimally invasive parathyroidectomy.

Method

2-cycles prospective study correlating SPECT and operative findings was conducted. All patients underwent ultrasound and SPECT, those with concordant findings on both modalities underwent minimally invasive parathyroidectomy, whilst patients with discordant findings on both modalities had central neck exploration. Following operative findings, recommendations of changing the SPECT reporting method such as surgically relevant structures adjacent to the lesion, such as the thyroid, were implemented. Following which, a second prospective study assessed the outcome of change.

Results

In the first cycle, 20 patients underwent partial parathyroidectomy, either by open (n = 13), or minimally invasive (n = 7) approach. SPECT sensitivity was 85% (n = 17) in identifying the adenoma. Out of all histologically confirmed adenomas, SPECT identified all adenomas (n = 17) on the correct side and 41% (n = 7) on the correct level (superior vs. inferior parathyroid). In the second cycle following recommendation, 14 patients had surgery, 9 as minimally invasive and 5 as open approach. SPECT sensitivity was 79% (n = 11) for adenoma identification. Of all confirmed adenomas, SPECT identifying adenomas at the correct side increased to 91% (n = 10) and correct level to 91% (n = 10).

Conclusions

SPECT alone is not yet regarded as gold standard in parathyroid adenoma localisation. The study has demonstrated that feedback to the radiologist of the operative findings may enhance its usefulness, particularly in attempting to proceed with a minimally invasive parathyroidectomy.

Leukocytes as a reservoir of circulating oncogenic DNA and regulatory targets of tumor-derived extracellular vesicles

Essentials Tumor-bearing mice were employed to follow oncogenic HRAS sequences in plasma, and blood cells. Cancer DNA accumulated in leukocytes above levels detected in exosomes, platelets and plasma. Extracellular vesicles and nucleosomes are required for uptake of tumor DNA by leukocytes. Uptake of tumor-derived extracellular vesicles by leukocytes triggers coagulant phenotype.

SUMMARY

Background Tumor-derived extracellular vesicles (EVs) and free nucleosomes (NSs) carry into the circulation a wealth of cancer-specific, bioactive and poorly understood molecular cargoes, including genomic DNA (gDNA). Objective Here we investigated the distribution of extracellular oncogenic gDNA sequences (HRAS and HER2) in the circulation of tumor-bearing mice. Methods and Results Surprisingly, circulating leukocytes (WBCs), especially neutrophils, contained the highest levels of mutant gDNA, which exceeded the amount of this material recovered from soluble fractions of plasma, circulating EVs, platelets, red blood cells (RBCs) and peripheral organs, as quantified by digital droplet PCR (ddPCR). Tumor excision resulted in disappearance of the WBC-associated gDNA signal within 2-9 days, which is in line with the expected half-life of these cells. EVs and nucleosomes were essential for the uptake of tumor-derived extracellular DNA by neutrophil-like cells and impacted their phenotype. Indeed, the exposure of granulocytic HL-60 cells to EVs from HRAS-driven cancer cells resulted in a selective increase in tissue factor (TF) procoagulant activity and interleukin 8 (IL-8) production. The levels of circulating thrombin-antithrombin complexes (TAT) were markedly elevated in mice harboring HRAS-driven xenografts. Conclusions Myeloid cells may represent a hitherto unrecognized reservoir of cancer-derived, EV/NS-associated oncogenic gDNA in the circulation, and a possible novel platform for liquid biopsy in cancer. In addition, uptake of this material alters the phenotype of myeloid cells, induces procoagulant and proinflammatory activity and may contribute to systemic effects associated with cancer.

Pain and health-related quality of life in people with chronic leg ulcers

INTRODUCTION

Venous leg ulceration is associated with pain and poor health-related quality of life (HRQL). The purpose of this study was to identify demographic and clinical characteristics associated with pain and decreased HRQL in patients with active venous ulcers.

METHODS

Baseline data were combined from two trials that took place between 2001 and 2007 (n = 564). Pain was measured using the Numeric Pain Scale (NPS), and HRQL was measured using the Medical Outcomes Survey 12-item Short Form (SF-12), which generates a Physical (PCS) and Mental Component Summary (MCS). Analyses included logistic and linear regression (for pain and HRQL, respectively).

RESULTS

Mean age was 66.5 years; 47% were male. Median NPS score was 2.2 (out of 10) and mean PCS and MCS scores were 38.0 and 50.5, respectively (scores are standardized to a mean of 50 representing average HRQL). Younger age, living with others, and arthritis were associated with pain. Poorer PCS was associated with being female, venous/mixed ulcer etiology, larger ulcers, longer ulcer duration, cardiovascular disease, arthritis and higher pain intensity. Poorer MCS was associated with younger age, longer ulcer duration, comorbidity and higher pain intensity.

CONCLUSION

Research is needed to test strategies to reduce pain and possibly improve HRQL in high risk groups.

Pain and health-related quality of life in people with chronic leg ulcers

Introduction

Venous leg ulceration is associated with pain and poor health-related quality of life (HRQL). The purpose of this study was to identify demographic and clinical characteristics associated with pain and decreased HRQL in patients with active venous ulcers.

Methods

Baseline data were combined from two trials that took place between 2001 and 2007 (n = 564). Pain was measured using the Numeric Pain Scale (NPS), and HRQL was measured using the Medical Outcomes Survey 12-item Short Form (SF-12), which generates a Physical (PCS) and Mental Component Summary (MCS). Analyses included logistic and linear regression (for pain and HRQL, respectively).

Results

Mean age was 66.5 years; 47% were male. Median NPS score was 2.2 (out of 10) and mean PCS and MCS scores were 38.0 and 50.5, respectively (scores are standardized to a mean of 50 representing average HRQL). Younger age, living with others, and arthritis were associated with pain. Poorer PCS was associated with being female, venous/mixed ulcer etiology, larger ulcers, longer ulcer duration, cardiovascular disease, arthritis and higher pain intensity. Poorer MCS was associated with younger age, longer ulcer duration, comorbidity and higher pain intensity.

Conclusion

Research is needed to test strategies to reduce pain and possibly improve HRQL in high risk groups.

ADAR1 is essential for intestinal homeostasis and stem cell maintenance

Adenosine deaminase acting on RNA 1 (ADAR1) is a double-stranded RNA-editing enzyme that converts adenosine (A) to inosine (I), and essential for normal development. In this study, we reported an essential role of ADAR1 in the survival and maintenance of intestinal stem cells and intestinal homoeostasis by suppressing endoplasmic reticulum (ER) stress and interferon (IFN) signaling. ADAR1 was highly expressed in the Lgr5+ cells, and its deletion in adult mice led to a rapid apoptosis and loss of these actively cycling stem cells in the small intestine and colon. ADAR1 deletion resulted in a drastic expansion of progenitors and Paneth cells but a reduction of three other major epithelial lineages. Moreover, loss of ADAR1 induced ER stress and activation of IFN signaling, and altered expression in WNT targets, followed by intestinal inflammation. An ER stress inhibitor partially suppressed crypt apoptosis. Finally, data from cultured intestinal crypts demonstrated that loss of ADAR1 in the epithelial cells is the primary cause of these effects. These results support an essential role of ADAR1 and RNA editing in tissue homeostasis and stem cells.

Assessment of the Likelihood of Invasive Breast Cancer When Core Needle Biopsy Shows DCIS

Background: Ductal carcinoma in-situ (DCIS) on core needle biopsy (CNB) may be associated with a final diagnosis of invasive cancer (IC). As patients with IC need axillary assessment, those at risk of upstaging may be appropriate for sentinel node biopsy (SNB) at initial surgery, preventing the need for re-operation. We assessed this risk using pre-operative factors to develop a management algorithm.Materials and Methods: All patients whose CNB showed DCIS or DCIS with microinvasion (DCISm) from a single population-based breast screening program in Australia between 1994 and 2006 were studied. Medical records were reviewed for demographic, radiologic, clinical and pathologic data.Results: 11 of 15 DCISm cases (73.3%) and 65 of 375 DCIS cases (17.3%) were upstaged to IC. Microinvasion on CNB overwhelmingly predicted presence of frank invasive cancer. For cases of DCIS, multivariate analysis showed that (1) palpability (p=0.009), (2) large mammographic size ≥20mm (p=0.001) and (3) prolonged screening interval ≥3 years (p=0.008) were associated with upstaging. On univariate analysis, (4) non-calcific mammographic features (mass, architectural distortion or non-specific density) were significantly associated with upstaging (p=0.001). There was a trend towards upstaging in patients with high grade DCIS on CNB (p=0.07). Factors not associated with upstaging were microcalcifications (p=0.12), comedonecrosis (p=0.14), age (p=0.38) and CNB method (p=0.50). The rate of upstaging increases with the number of associated risk factors present in a patient: 8.3% in patients with no risk factors, 21.2% in those with one risk factor, 38.6% in those with two risk factors, and 52.9% in those with three risk factors. 13 patients (3.3%) had lymph node metastases.Conclusions: The risk of upstaging can be estimated using pre-operative features in patients with DCIS on CNB. We propose a management algorithm that includes SNB for DCIS patients: with microinvasion on core biopsy, with two or more predictive factors, and those with planned total mastectomy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3111.

Normal incidence detection of ultraviolet, visible, and mid-infrared radiation in a single GaAs/AlGaAs device

A GaAs/AlGaAs detector is demonstrated showing multiple detection capabilities. This detector exhibits a broad spectral response in the 200-870 nm (ultraviolet-visible) range for forward bias and in the 590-870 nm (visible) range for reverse bias. In the mid-IR region, two peaks at 5 and 8.9 microm can be observed for low and high forward bias voltages, respectively. In addition, the peak at 8.9 microm is sensitive to the polarization of the incoming radiation.

Associations between chronic disease, age and physical and mental health status

This paper examines the associations between chronic disease, age, and physical and mental health-related quality of life (HRQOL), using data collected in 10 studies representing five chronic conditions. HRQOL was measured using the SF-36 or the shorter subset, SF-12. Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were graphed by condition in age increments of 10 years, and compared to age- and sex-adjusted normative data. Linear regression models for the PCS and MCS were controlled for available confounders. The sample size of 2418 participants included 129 with renal failure, 366 with osteoarthritis (OA), 487 with heart failure, 1160 with chronic wound (leg ulcer) and 276 with multiple sclerosis (MS). For the PCS, there were large differences between the normative data and the mean scores of those with chronic diseases, but small differences for the MCS. Female gender and comorbid conditions were associated with poorer HRQOL; increased age was associated with poorer PCS and better MCS. This study provided additional evidence that, while physical function could be severely and negatively affected by both chronic disease and advanced age, mental health remained relatively high and stable.

Associations between chronic disease, age and physical and mental health status

This paper examines the associations between chronic disease, age, and physical and mental health-related quality of life (HRQOL), using data collected in 10 studies representing five chronic conditions. HRQOL was measured using the SF-36 or the shorter subset, SF-12. Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were graphed by condition in age increments of 10 years, and compared to age- and sex-adjusted normative data. Linear regression models for the PCS and MCS were controlled for available confounders. The sample size of 2418 participants included 129 with renal failure, 366 with osteoarthritis (OA), 487 with heart failure, 1160 with chronic wound (leg ulcer) and 276 with multiple sclerosis (MS). For the PCS, there were large differences between the normative data and the mean scores of those with chronic diseases, but small differences for the MCS. Female gender and comorbid conditions were associated with poorer HRQOL; increased age was associated with poorer PCS and better MCS. This study provided additional evidence that, while physical function could be severely and negatively affected by both chronic disease and advanced age, mental health remained relatively high and stable.

The development of participatory health research among incarcerated women in a Canadian prison

This paper describes the development of a unique prison participatory research project, in which incarcerated women formed a research team, the research activities and the lessons learned. The participatory action research project was conducted in the main short sentence minimum/medium security women's prison located in a Western Canadian province. An ethnographic multi-method approach was used for data collection and analysis. Quantitative data was collected by surveys and analysed using descriptive statistics. Qualitative data was collected from orientation package entries, audio recordings, and written archives of research team discussions, forums and debriefings, and presentations. These data and ethnographic observations were transcribed and analysed using iterative and interpretative qualitative methods and NVivo 7 software. Up to 15 women worked each day as prison research team members; a total of 190 women participated at some time in the project between November 2005 and August 2007. Incarcerated women peer researchers developed the research processes including opportunities for them to develop leadership and technical skills. Through these processes, including data collection and analysis, nine health goals emerged. Lessons learned from the research processes were confirmed by the common themes that emerged from thematic analysis of the research activity data. Incarceration provides a unique opportunity for engagement of women as expert partners alongside academic researchers and primary care workers in participatory research processes to improve their health.

Quantum dots for terahertz generation

Nanostructures made of semiconductors, such as quantum wells and quantum dots (QD), are well known, and some have been incorporated in practical devices. Here we focus on novel structures made of QDs and related devices for terahertz (THz) generation. Their potential advantages, such as low threshold current density, high characteristic temperature, increased differential gain, etc, make QDs promising candidates for light emitting applications in the THz region. Our idea of using resonant tunneling through QDs is presented, and initial results on devices consisting of self-assembled InAs QDs in an undoped GaAs matrix, with a design incorporating a GaInNAs/GaAs short period superlattice, are discussed. Moreover, shallow impurities are also being explored for possible THz emission: the idea is based on the tunneling through bound states of individual donor or acceptor impurities in the quantum well. Initial results on devices having an AlGaAs/GaAs double-barrier resonant tunneling structure are discussed.

Pattern formation in draining thin film suspensions

We demonstrate the emergence of complexity from remarkably simple and ubiquitous systems: draining thin-film suspensions exhibiting a striking transition between two classes of self-organizing patterns. Vertical channels form when attractive forces lead to transient gelation, while horizontal bands result from granular mixtures. We propose an explanation whereby the generic physical mechanisms require only the existence of viscous and excluded-volume couplings among the particles, solvent, and substrate. System-specific, small inhomogeneities trigger large-scale pattern formation, through collective dynamics, where jamming plays a crucial role. Our results shed light on emergent complexity in bio- and geophysical processes and have implications for coatings and food industries.

Incidence of sports injuries in elite competitive and recreational windsurfers

OBJECTIVE

To investigate the incidence of injury in windsurfing and to consider methods of prevention.

METHODS

A total of 107 raceboard (RB) and wave/slalom (WS) national/international competitors and recreational (REC) windsurfers completed a questionnaire on injury incidence over two years. Recurrent injury, ability level, and any preventive measures taken were noted.

RESULTS

Overall the injury incidence was 1.5/person/year. The WS group suffered more injuries (2.0/person/year) than the RB (1.0) or REC (1.2) group. The most common injury was muscle strain at 35% of new injuries, much higher than in earlier studies. Overall 45% of new injuries were muscle/tendon strains (RB 55%, WS 42%, and REC 43%) and 8% were ligament sprains. In the WS group cuts and abrasions were common. The WS and REC groups reported five and one case of concussion respectively. Nearly a quarter (22%) of new lower body injuries were lower back muscular strain, with 34% of recurrent injuries. Approximately 60% of the remaining lower body soft tissue injuries involved the knee or lower leg, with the ankle/foot most often involved. The shoulder, upper arm, and elbow were the sites of 41% of new upper body soft tissue injuries. The WS group reported 250% more recurrent muscular strains than the RB group. Recurrent ligament injuries (particularly knee) were most common in the WS group. The RB group reported recurrent serious bruising to the lower leg.

CONCLUSION

The injury incidence was 1.5/person/year with a high incidence of new and recurrent muscular strain. Lower back muscular strain was prevalent, indicating the need for preventive measures. Wave/slalom was associated with more new and recurrent injuries and the need for head protection.

High-frequency microrheology of wormlike micelles

We have measured the frequency-dependent shear modulus of entangled solutions of wormlike micelles by high-frequency microrheology and have compared the results with those from macrorheology experiments done on the same samples. Using optical microrheology based on laser interferometry we have measured loss and storage moduli over six decades in frequency up to about 100 kHz. We present data over a decade in concentration in the entangled regime and find good agreement between micro- and macrorheology, thus validating recently developed microrheology techniques. By collapsing data for different concentrations, we furthermore determine both the concentration scaling of the plateau modulus and a power-law exponent of the complex shear modulus at high frequencies.

EUROPA DONNA: has strength in its heterogeneity

EUROPA DONNA, a non-profit-making organisation, is a pan-European movement against breast cancer; it is a coalition that is active in 29 countries, each organised into national independent Fora. In each Forum, a postal survey was conducted between 2001 and 2002. A standardised questionnaire was used to collect information about Forum characteristics and activities, and perceptions of the adequacy of the local health service in relation to the prevention, diagnosis and treatment of breast cancer. Twenty-seven Fora (93%) participated in the survey. The results show the heterogeneity between the Fora in the services offered and activities in the different countries. The Fora also perceived a range of deficiencies in the prevention, diagnosis and treatment of breast cancer within their national health systems. These results highlight the importance of a coalition to establish a consensus among the Fora, and the need for coordinated initiatives in different European countries.

Reliability and validity of a modified Colorado Symptom Index in a national homeless sample

This study examined the reliability and construct validity of a modified version of the Colorado Symptom Index (MCSI), a brief, self-report measure of psychological symptomatology, in a study of interventions to prevent homelessness. Eight projects in a national, cooperative study collected new data at baseline, 6, and 12 months using a set of common measures as well as site-specific instruments. The pooled sample consisted of 1,381 persons in treatment for mental illness or substance abuse (or both), of which 84% had a history of homelessness. The analyses employed classical and Rasch methods to examine the MCSI's content validity, internal consistency and item quality, test/retest reliability, dimensionality, appropriateness for the sample, construct validity, and responsiveness to change. This 14-item scale was found to be a reliable and valid measure of psychological symptoms in this sample. Its content was consistent with other symptom measures, its high internal consistency and test-retest coefficients supported its reliability, its relationships to other measures indicated that it had good construct validity, and it was responsive to change. We conclude that the MC

A randomized controlled crossover study comparing synthetic porcine and human secretins with biologically derived porcine secretin to diagnose Zollinger-Ellison Syndrome

BACKGROUND

Although biologically-derived porcine secretin is approved for the diagnosis of Zollinger-Ellison Syndrome, it is no longer available in the United States. Pure human and porcine secretins have now been synthesized and new drug applications have been filed with the Federal Drug Administration (FDA).

METHODS

In the current study we compared secretin testing results in six confirmed Zollinger-Ellison Syndrome patients using the biologically-derived product and both synthetic products (human and porcine) in a three-way, randomized, single-blind Latin-squares crossover study.

RESULTS

Using the FDA-approved criterion for positive secretin testing (i.e. a serum gastrin concentration increase of > 110 pg/mL), there was complete agreement between all three agents for all patients. With the more stringent NIH criterion (i.e. a serum gastrin concentration increase of > 200 pg/mL), positive results persisted in five out of six, six out of six and four out of six patients using biologically-derived secretin, synthetic porcine secretin, and synthetic human secretin, respectively (six out of six, six out of six and four out of six if a positive test was defined as a 50% increase in serum gastrin concentration). The time to peak serum gastrin concentration after secretin injection occurred within 15 min in all studies (in 94% by 10 min and in 77% by 5 min). Three-way comparisons of serum gastrin concentrations showed a single statistically significant difference (the change from baseline at 15 min between synthetic human and synthetic porcine secretin, P=0.0274). Statistically significant changes from baseline occurred at 1, 2 and 5 min for biologically-derived porcine secretin and at 2 and 5 min for both synthetic porcine and synthetic human secretin, in keeping with the expected time curve for positive tests. All three agents were well-tolerated.

CONCLUSIONS

These data suggest that either synthetic secretin product, when released onto the United States market, can be used to confirm Zollinger-Ellison Syndrome.

Kinetic pathways of multiphase surfactant systems

Relaxation following a temperature quench of two- (L(alpha) and L3) and three-phase (L(alpha), L3, and L1) samples has been studied in a sodium dodecyl sulfate-octanol-brine system. In the three-phase case we have observed samples that are initially mainly of the sponge phase, with lamellar and micellar phases on the top and bottom of the sample, respectively. Upon decreasing the temperature, most of the volume of the sponge phase is replaced by the lamellar phase. During equilibration we have observed three regimes of behavior within the sponge phase: (i) first there is disruption in the L3 texture, then (ii) after the sponge phase homogenizes there is a L(alpha) nucleation regime; finally (iii), a bizarre plume connects the L(alpha) phase with the L1 phase. The relaxation of the two-phase sample proceeds instead in two stages. First L(alpha) drops nucleate in L3, forming an onion "gel" structure. Over time the L(alpha) structure compacts while equilibrating into a two-phase L(alpha)-L3 sample. We offer possible explanations for some of these observations in the context of a general theory for phase kinetics in systems with one fast composition variable and one slow.

High incidence of micrometastases in breast cancer sentinel nodes

BACKGROUND

Sentinel lymph node biopsy (SLNB) is being investigated as an alternative to formal axillary dissection in early breast cancer. Avoiding the morbidity of unnecessary axillary dissection is seen as the main potential benefit of SLNB. Sentinel lymph node biopsy also allows enhanced pathological analysis. A series of 62 sentinel node (SN) biopsies demonstrating a high incidence of micrometastases is presented here.

METHODS

All SN were initially examined and reported by H&E staining. All negative SN were analysed after staining with polyclonal anticytokeratin antibody.

RESULTS

Sixty-two patients underwent SLNB at Royal Melbourne Hospital between May 1998 and February 2000. One or more SN was identified in 51/62 patients. A total of 10/51 contained metastases identified after H&E staining. There was one false negative. A total of 10/41 patients with H&E-negative SN had micrometastases identified on immunohistochemistry (IHC). Micrometastases were more common in patients with larger tumours, with disease found in the H&E-negative SN of 1/17 T1a and T1b (1-10 mm), 4/15 T1c (11-20 mm), and 5/9 T2 (20-50 mm) tumours.

CONCLUSION

Sentinel lymph node biopsy can accurately assess the axilla in most patients with early breast cancer. A significant proportion of histologically negative SN will have micrometastases identifiable with IHC. Although the clinical significance of such metastases is uncertain, the available evidence suggests that these patients have a poorer prognosis than other patients with negative lymph nodes.

Arrays of multielement ultrasound applicators for interstitial hyperthermia

Arrays of multielement ultrasound applicators for interstitial hyperthermia have been developed and tested both in vitro and in vivo. The system includes multielement applicators, a 64 channel RF driving unit, a power measuring unit, a 112 channel multisensor temperature measuring unit, and a water cooling unit. Ninety-five arrays of single-element and nine arrays of three-element ultrasound applicators were designed, built, and characterized by measuring transducer efficiency and ultrasound field distribution. Improved uniformity in the azimuthal direction was achieved by using multiple driving frequencies. In addition, production of ultrasound in a desired sector of the transducer was possible by selecting a suitable frequency. Both in vitro and in vivo experiments showed that 92% of monitored temperature points within the target volume of 30 mm x 30 mm x 35 mm achieved a therapeutic temperature rise (above 5 degrees C) when an array of five three-element applicators were used. These results indicated that the arrays of multielement ultrasound applicators have distinct advantages over present interstitial hyperthermia modalities in terms of the capability to control the temperature distribution with a large catheter spacing. As a conclusion, the feasibility of a practical arrays of multielement ultrasound applicators for interstitial hyperthermia was demonstrated.

Long-wavelength infrared (~10-15 mm) electroluminescence from Sb-based interband cascade devices

Electroluminescence in the long-wavelength infrared (10-15 mm) spectrum region was observed from Sb-based type-II interband cascade quantum well structures. The device structure was grown by molecular beam epitaxy on a GaSb substrate and comprises 10 repeated periods of active regions separated by digitally graded multilayer injection regions. The devices have been operated at 300 K and 77 K, with an output optical power up to 50 nW. The emission wavelength, the longest observed in any compound semiconductor material at room temperature, results from tailoring the heterostructure, demonstrating a unique capability of this Sb-family type-II material system.

Dermatofibrosarcoma protuberans

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive soft tissue sarcoma in which recurrences are common. It usually affects middle-aged individuals with the most common location being the trunk. Sex distribution varies among published series. Mohs surgery is the treatment of choice. Immunostaining for CD34 facilitates the diagnosis of DFSP and aids in indicating the surgical margins of the tumor; however, the sensitivity of this marker is variable.

MATERIALS AND METHODS

This is a retrospective review of 16 cases of DFSP treated with Mohs surgery at Duke University Medical Center between 1981 and 1994. Clinical and histologic features are analyzed. Immunohistochemical stains for CD34 were performed in one case.

RESULTS

Twelve of the 16 patients were women with four younger than 20 years. The most common location was the trunk. No recurrences following Mohs surgery have been documented. The average number of stages during Mohs surgery was 3.3. Surgical wounds were repaired by complex layered closure in 11 cases. Stains for CD34 were negative on the initial biopsy, but were positive on frozen sections.

CONCLUSIONS

Both sexes and all age groups are affected by DFSP. Mohs surgery is the treatment of choice and offers a significant improvement in cure rates with the cosmetic advantage of smaller postoperative wounds. Immunostains for CD34 appear to be an important adjunct to facilitate tumor removal, but the variable expression of CD34 antigen by DFSP tumors can lead to variable staining patterns.

A primary intraosseous carcinoma of the anterior maxilla. Report of a new case

The case of a primary intraosseous carcinoma occurring in the maxilla is presented. The classification; clinical, radiologic, and light microscopic features; and treatment are described. These rare lesions should be considered among the diagnostic possibilities when patients present with atypical cysts of the jaws.

Electromyographic activity during windsurfing on water

Electromyographic activity and the electrocardiogram were recorded during windsurfing on the water in six subjects (three females and three males). 'Beating' and 'reaching' (both with continuous pumping), 'running' and 'uphauling' were performed in light to moderate winds. The physiological signals were transmitted to a shore base by radio telemetry and recorded with synchronized video and audio information of movement. Heart rates were similar for the beating, reaching and running activities within the individuals, but varied between individuals (means of 145 to 173 beats min-1), due to performance conditions and related muscle activity levels. During beating and reaching, the trapezius, flexor carpi ulnaris, extensor carpi radialis, biceps brachii and tibialis anterior were very active, with the gluteus maximus being particularly important in beating. Running involved less general muscle activity, though the role of the tibialis anterior increased. Differences in technique were identified between the subjects, notably in the order of muscle recruitment to participate in the activities.

Electromyographic activity of beating and reaching during simulated boardsailing

This study examined the responses of six competitive boardsailors (three males, three females) during laboratory-based simulation tasks while the electromyographic activity of up to 13 muscles was recorded. A sailboard, mounted in a steel frame and resting on a waterbed, allowed simulation of roll and pitch movements. Wind force was simulated by attaching the boom to a weight stack with a hydraulically controlled buffered release phase. The progression of the simulation test was controlled by the sailor copying movements on an edited video of each subject boardsailing on the open water. Analysis of individual pumping movements for mean peak percentage of maximal enveloped voluntary contraction (%MEVC) in 'beating' and 'reaching' showed that muscular activity in the arm (flexor carpi ulnaris, extensor carpi radialis and biceps brachii) was greatest (66-94% MEVC), with considerable activity (58-75% MEVC) in the deltoid and trapezius shoulder muscles, but much less activity in the leg muscles (16-40% MEVC). For the combined upper and lower body muscles there was a significant difference (P < 0.001) between 'beating' and more physically demanding 'reaching' pumping activity. Electromyographic activity was higher than reported previously during simulation, reflecting the current dynamic nature of the sport.

Human recombinant stem-cell factor induces melanocytic hyperplasia in susceptible patients

BACKGROUND

Recombinant human stem-cell factor (SCF), a cytokine acting on hematopoietic progenitor cells, has potential for the treatment of several hematologic and oncologic disorders. In a hematology-oncology phase I trial of SCF, several patients had cutaneous hyperpigmentation at the SCF subcutaneous injection sites.

OBJECTIVE

Our purpose was to investigate the pathogenesis of this hyperpigmentation phenomenon.

METHODS

Skin biopsy specimens were obtained before, at the completion of, and after SCF therapy and were processed for histology, immunohistology, and electron microscopy.

RESULTS

Skin at the site of SCF injection had an increased number of melanocytes, increased melanocytic dendrite extension, and melanin as compared with noninjected tissue. Immunohistochemical stains revealed an increase in staining with melanocyte-specific monoclonal antibodies HMB-45 and NKI/beteb, and a monoclonal antibody to the receptor for SCF, c-kit.

CONCLUSION

Subcutaneous injection of SCF results in hyperplasia of melanocytes. SCF may be useful in the treatment of melanocytopenic disorders, but caution may be necessary in patients with disorders of melanocyte proliferation.

Enabling patients to make informed decisions

Patient consent is often obtained to avoid litigation. The author of this paper argues that there is a moral and legal imperative to help patients come to decisions that are informed and looks at why this often does not happen.