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A report of 3 cases of a new renal cell tumor entity with a review of clinical data and all histological slides are presented. A study was performed which showed that tumor cells were low cuboidal, slightly eosinophilic with low nuclear grade.

AbstractAimsChildhood adversities (CAs) predict heightened risks of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) among people exposed to adult traumatic events. Identifying which CAs put individuals at greatest risk for these adverse posttraumatic neuropsychiatric sequelae (APNS) is important for targeting prevention interventions.MethodsData came from n= 999 patients ages 18–75 presenting to 29 U.S. emergency departments after a motor vehicle collision (MVC) and followed for 3 months, the amount of time traditionally used to define chronic PTSD, in the Advancing Understanding of Recovery After Trauma (AURORA) study. Six CA types were self-reported at baseline: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect and bullying. Both dichotomous measures of ever experiencing each CA type and numeric measures of exposure frequency were included in the analysis. Risk ratios (RRs) of these CA measures as well as complex interactions among these measures were examined as predictors of APNS 3 months post-MVC. APNS was defined as meeting self-reported criteria for either PTSD based on the PTSD Checklist for DSM-5 and/or MDE based on the PROMIS Depression Short-Form 8b. We controlled for pre-MVC lifetime histories of PTSD and MDE. We also examined mediating effects through peritraumatic symptoms assessed in the emergency department and PTSD and MDE assessed in 2-week and 8-week follow-up surveys. Analyses were carried out with robust Poisson regression models.ResultsMost participants (90.9%) reported at least rarely having experienced some CA. Ever experiencing each CA other than emotional neglect was univariably associated with 3-month APNS (RRs = 1.31–1.60). Each CA frequency was also univariably associated with 3-month APNS (RRs = 1.65–2.45). In multivariable models, joint associations of CAs with 3-month APNS were additive, with frequency of emotional abuse (RR = 2.03; 95% CI = 1.43–2.87) and bullying (RR = 1.44; 95% CI = 0.99–2.10) being the strongest predictors. Control variable analyses found that these associations were largely explained by pre-MVC histories of PTSD and MDE.ConclusionsAlthough individuals who experience frequent emotional abuse and bullying in childhood have a heightened risk of experiencing APNS after an adult MVC, these associations are largely mediated by prior histories of PTSD and MDE.

This paper covers circuits and systems techniques for the construction of high reliability biosensing and stimulation medical devices. Such microsystems are dedicated for interconnections through either the central or the peripheral nervous systems. Low-power high-reliability wireless links are used to power up the implanted devices while data are exchanged bidirectionaly between these implants and external controllers. A global view of main devices is given, case studies related to applications such as bladder control, intracortical monitoring and microstimulation are discussed, altogether with modeling, characterization, as well as microsystems assembly and packaging. Also, dedicated electrode arrays and their interfaces to tissues interfaces are summarized.

This paper covers circuits and systems techniques for the construction of high reliability biosensing and stimulation medical devices. Such microsystems are dedicated for interconnections through either the central or the peripheral nervous systems. Low-power high-reliability wireless links are used to power up the implanted devices while data are exchanged bidirectionaly between these implants and external controllers. A global view of main devices is given, case studies related to applications such as bladder control, intracortical monitoring and microstimulation are discussed, altogether with modeling, characterization, as well as microsystems assembly and packaging. Also, dedicated electrode arrays and their interfaces to tissues interfaces are summarized.

Sarcomatoid renal cell carcinomas (SRC) are rare neoplasms associated with a very poor prognosis. The aim of this study was to evaluate biomarker expression and clinical significance in this uncommon renal cancer. Cytokeratin, epithelial membrane antigen, vimentin, desmin, smooth muscle actin, CD34, S-100 protein, MIB 1, p53, Fas and Fas ligand immunohistochemical expression was investigated in seven renal cell carcinomas with sarcomatoid changes. No significant difference between sarcomatoid and nonsarcomatoid areas was observed with the different biomarkers, excepted for Fas ligand. Fas expression was diffuse in sarcomatoid and nonsarcomatoid areas. However, Fas ligand had a higher expression in sarcomatoid in comparison to nonsarcomatoid areas. Our results showed that Fas and Fas ligand are both expressed in renal cancer. We suggest that the aggressive behavior of sarcomatoid carcinoma may be related to a higher expression of Fas ligand by tumor sarcomatoid cells. These findings may indicate that Fas ligand is a possible therapeutic molecular target for treatment of SRC.

To study the results of surgical treatment of primary lung sarcoma.

We report a case of nodular granulomatous Pneumocystis carinii pneumonia following bone marrow transplantation.

The patient was a 40-year-old man who had undergone bone marrow transplantation for myeloblastic acute leukemia. He presented with fever, dyspnea and bilateral diffuse nodular infiltration of the lungs. Bronchoalveolar lavage was negative. Open lung biopsy was performed. Histological examination revealed a granulomatous reaction with central necrosis surrounded by epithelioid and giant cells. Toluidine blue and Gomori-Grocott stains identified a few P. carinii. Mycobacterial and fungal cultures were negative. A granulomatous reaction is rarely observed and almost only in HIV-infected patients. To our knowledge this is the first description in a bone marrow transplant recipient.

Human mucous proteinase inhibitor (MPI) is present in bronchial secretions, where it participates in the protection of lung structures against degradation by leukocyte elastase. The protein has been localized by immunohistochemical studies and immunogold labeling essentially in the serous cells of the submucosal glands and also in the surface epithelial cells of central and peripheral airways. However, until now no gene expression study has been performed at the tissue level. In this study, in situ hybridization was used to precisely study MPI mRNA expression in bronchial tissue sections with a specific radiolabeled oligonucleotide probe. By light microscopy, MPI gene expression was localized exclusively in the serous and seromucinous acini of the submucosal glands of large airways. The MPI gene was expressed in submucosal glands of normal and carcinomatous tissue sections, whereas it was not expressed in bronchial and bronchiolar surface epithelia.

Summary We retrospectively analyzed overall survival and survival after progression in 91 patients with low-grade follicular lymphoma (LGFL). Histological subtype was B in 75 patients and C in 16 patients. Twelve patients with localized disease received involved-field radiotherapy; seven patients without bulky disease had no initial therapy. The remaining 72 patients received long-term chlorambucil (9 patients), MOPP or COPBleo (42 patients), or a CHOP-derived regimen (21 patients). Forty-two patients (46%) achieved a complete remission (CR) and 28 patients (31%) achieved a partial remission; 48 of these 70 patients relapsed or progressed. Nineteen of the other 21 patients with stable LGFL progressed. Two other patients failed to respond and rapidly died. Thirty-two of the 67 patients with progressive or relapsed LGFL have died. Median overall survival was 111 months. Age =70 years, male sex, B symptoms, histological subtype follicular mixed-cell NHL, tumor size =10 cm, number of extranodal sites of disease =2, pleural effusion, and Ann Arbor stage III or IV were found to adversely influence overall survival. Failure-free survival < 24 months, failure to achieve a CR after the progression, initial histological subtype follicular mixed cell, initial Ann Arbor stage III or IV, and initial tumoral size =10 cm were found to adversely influence survival after progression. Our results suggest that most prognostic factors for overall survival in LGFL are related to histological subtype or tumor burden. Some initial adverse prognostic factors for survival may be also associated with a poor survival after progression.

In this paper, we address the possibilities offered by hybrid harmonic/stochastic (H/S) models in the context of wide-band text-to-speech synthesis based on segment concatenation. After a brief recall of the hypotheses underlying such models and a comprehensive review of a well-known analysis algorithm, namely the one provided by the multi-band excited (MBE) analysis framework, we study how H/S models allow to modify the prosody of segments and how segment concatenation can be organized, in the purpose of minimizing mismatches at the border of segments. In this context, we introduce an original concatenation algorithm which takes advantage of some analysis errors. Speech synthesis algorithms are then described, including an original synthesis technique based on judiciously prepared IFFTs, and the final segmental quality11Segmental quality, in TTS synthesis, is the ability of a synthesizer to produce natural-sounding speech sounds. It is opposed to supra-segmental quality, which relates to the adequacy of the pitch and phoneme durations computed by the language processing block of the TTS system to the sentence to be synthesized. is detailed. More particularly, we examine the differences in the quality obtained when using the model in a narrow-band speech coding context and in a wide-band, concatenation based synthesis context. We study three possible causes for these differences: the choice of an analysis criterion, the inadequacy of the model due to pitch variatons, and the effect of coarticulation on phases.

T lymphocytes and eosinophils are important components of the inflammatory cell infiltrate in bronchial mucosa in asthma. Because activated lymphocytes migrate through the thoracic duct and the general circulation to remote glandular and mucosal sites, we initiated this study to evaluate pathological abnormalities and immunoreactivity for interleukin (IL) 3, IL-5, and granulocyte/macrophage colony-stimulating factor (GM-CSF) of intestinal mucosa in bronchial asthma. 15 asthmatic patients, 8 nonasthmatic patients with chronic obstructive pulmonary disease, 6 atopic nonasthmatic healthy controls, and 6 nonatopic healthy controls were studied. Duodenal biopsies were performed by endoscopy. A significantly increased number of intraepithelial lymphocytes and eosinophils and a significant accumulation of mononuclear cells (lymphocytes and mast cells) and eosinophils in the lamina propria were detected in asthmatics and atopic controls. Immunostaining with antibodies directed against IL-3, IL-5, and GM-CSF was positive in asthmatics and atopic controls, whereas no staining was observed in nonatopic controls and chronic obstructive pulmonary disease. Combined ultrastructural study and immunogold labeling demonstrated that IL-3, IL-5, and GM-CSF were localized in eosinophils and mast cells. Although devoid of gastrointestinal symptoms, asthmatics and asymptomatic atopics had duodenal pathological abnormalities mimicking those observed in the bronchial mucosa in asthma, suggesting that the whole mucosal immune system is involved in bronchial asthma.

Summary Eosinophils from two patients with eosinophilic granuloma of bone (EGB) were studied by combined immunohistochemical and immuno-ultrastructural methods with antibodies directed against three eosinophil granule proteins: major basic protein, eosinophil cationic protein, and eosinophil peroxidase. Immunohistostaining showed the presence and distribution of large numbers of eosinophils in the granuloma. Immuno-ultrastructural methods showed alterations of eosinophil fine structure associated with some steps in the release of granule proteins. No granule extrusion was seen, but rather cationic proteins diffused within cytoplasmic tubulo-vesicular structures. Furthermore, the three granule proteins were found within phagolysosomes of surrounding macrophages, suggesting an interaction between eosinophils and phagocytic cells at the destructive stage of EGB.

Summary Three cases of splenic involvement in three different types of generalized mastocytosis (systemic mast cell disease) are reported. The macroscopic, histological and ultrastructural modifications of the spleen are described. Each case exhibited a different morphological pattern. Giemsa staining, fluorescence after acridine orange staining and naphthol ASD chloracetate esterase reaction are shown to be valuable for diagnosis. By comparison, immunohistochemistry seemed not to be very useful, because no specific antigens are expressed. These findings are compared to previously published cases. Their value for the diagnosis and the prognosis are discussed.

Erdheim-Chester disease is a distinctive pathological radiographic entity, most commonly characterised by a typical skeletal involvement resulting from histiocytic infiltration of the bone marrow. Although lung involvement is often absent, we report a case of diffuse infiltrative lung disease characterised by a wide-spread reticular pattern on high-resolution CT scans associated with cystic airspaces and mild honeycombing observed throughout both lungs. Interstitial infiltration with lipid-laden histiocytes was histologically confirmed by means of transbronchial biopsy.

Background Retroperitoneoscopy (RPS) is a form of direct vision endoscopy, used to explore the retroperitoneal space, and was first described by Bartel in 1969.
Methods RPS was performed prospectively to diagnose infiltrating retroperitoneal lymphadenopathy or masses when needle aspiration biopsy under computed tomographic guidance (NABCT) failed to establish a definite diagnosis.
Results From May 1985 to August 1995, RPS was performed in 118 patients (121 procedures). Mean hospital stay was 2·4 (range 2-5) days. The peroperative and perioperative morbidity rate was 6·6 per cent of the procedures. A precise diagnosis was obtained in 108 of the 118 patients. The sensitivity was 84 per cent for malignant lymphoma, 94 per cent for Hodgkin's lymphoma, 95 per cent for metastatic lymph nodes of carcinomas and 100 per cent for primary retroperitoneal tumours. The overall sensitivity was 91·5 per cent.
Conclusion RPS is an alternative procedure to NABCT when aspiration biopsy is not technically feasible because a lesion is too small to sample or failed to establish a precise histopathological diagnosis.

Amberlite XAD 4 resin hemoperfusion was studied in the treatment of massive digitoxin overdosage. In vitro experiments using 4 hour resin hemoperfusion showed that digitoxin is removed 100 percent from an isotonic saline reservoir, 83 ± 14 percent from plasma, and 42 ± 7 percent from whole blood. In dogs, serum level reduction is fast: 50 ± 12 percent in 15 minutes, 71 ± 6 percent in 180 minutes; mean plasma clearance is 24 ± 6.5 ml/min for a 150 ml/min plasma flow rate. Eleven patients with massive digitoxin overdosage recovered with resin hemoperfusion. Serum level reduction was 32 ± 14 percent with a 325 g resin column, 59 ± 6 percent with two 325 g resin columns in series as compared with a 4.5 ± 1.7 percent reduction without perfusion. Hemoperfusion increased the rate of spontaneous removal of digitoxin 8.6 ± 3.3 times with a 325 g resin column, and 14 ± 7.4 times with two 325 g resin columns.

During a 25-year period 69 patients whose ages ranged from 1 day to 64 years were treated for bronchogenic cyst of the mediastinum. The male-to-female sex ratio was 1:0.76. The cysts were symptomatic in 63.7%, compressive in 43.4%, and life threatening in 2.8% of cases. Symptoms and signs of compression were more frequent in infants and children than in adults. Such symptoms and signs were more dependent on the location of the cyst than on its volume. The preoperative diagnosis was wrong in 16% of cases. The cysts were approached through thoracotomy in 67 cases, including one conversion from thoracoscopy, and through cervicotomy and mediastinoscopy in one case each. The cysts opened into the respiratory tract in five cases. No communication with the esophageal lumen was observed. The cystic contents were apparently infected in three cases, but samples remained sterile at culture. There was one hospital death caused by a centrally located compressive cyst that was undiagnosed at thoracotomy. The postoperative morbidity rate was 13.4%. There were no further symptoms after operation in children, but five adults reported continuing pain or dyspnea. Resection of bronchogenic cysts is recommended because of uncertainties in diagnosis and in evolution. (J THORAC CARDIOVASC SURG 1995; 109: 1003-10)

A 4-month-old infant was admitted with a monoblastic infiltration of the skin associated with osteosclerosis. Both lesions spontaneously disappeared within a few months, but 2 years later, a monoblastic leukemia occurred that was associated with marked skin erythema and myelofibrosis. Skin and bone marrow specimens showed a monoblastic infiltration with numerous intermingled mast cells of normal appearance. Whether myelofibrosis was a feature of a systemic mastocytosis or of the leukemic process is discussed in this case.

In recent years considerable advances have been made in our knowledge of the peptide moiety of human mucins through cDNA cloning. In many diseases disorders in mucin biosynthesis are observed, which result either from changes in the synthesis of the carbohydrate side chains or from differences in the relative expression of the different apomucins, each of which may affect physical properties of the viscous gel. We describe in situ hybridization studies on healthy human mucosae with five different oligonucleotide probes corresponding to each of the human genes known to date that encode secreted mucins, i.e., MUC 2, 3, 4 (HGM nomenclature) and 5B, 5C (proposed name). These genes present a nucleic tandem repeat organization. The choice of oligonucleotide probes was made to amplify the signal by hybridization of many small probes on the same mRNA molecules. A characteristic pattern of mucin gene expression was observed for each mucosa.

Abstract: The coagulation effect of a continuous-wave neodymium-YAG (Nd-YAG) laser and of a high-power (500 W) pulsed (3–500 ms) microcomputer-controlled Nd-YAG laser are compared in rat liver in vivo. In a series of 68 animals, surface temperature was measured with an infrared camera, and necrosed volume was assessed histologically 24 h after laser irradiation. The high-power pulsed Nd-YAG laser presents two interesting features. First, it gives a better control of surface temperature. Second, a controlled sequence of high-power short pulses produces a predictable coagulated volume which can be comparable to that obtained with continuous-wave Nd-YAG or argon lasers.

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An unusual case of neonatal bowel obstruction is presented. The patient had bilious vomiting and a tender left abdominal mass, which at operation proved to be an avulsed spleen adherent to the small bowel mesentery, with no signs of significant haemorrhage. Theories of events that led to this rare occurrence are discussed.