Clinical significance of P-glycoprotein immunohistochemistry and histomorphologic factors in patients with osteosarcoma

Osteosarcoma is the most frequent highly malignant bone tumor with a peak incidence in the second decade of life. Although survival rate increased up to 60-70% within the last 10 years, the problem of unresponsiveness to chemotherapy remains. In this study, we sought to determine the prognostic significance of P-glycoprotein as a tumor marker for osteosarcoma. In a retrospective study, we correlated P-glycoprotein immunostaining with clinicopathologic and histomorphologic features of the tumor and the patient outcome in 30 cases with primary, non-metastatic, highgrade osteosarcoma who were homogeneously treated. P-glycoprotein positivity was found in 14 of 30 cases and was significantly associated with a higher incidence of adverse events and relapse rate. No relationship was found between p-glycoprotein immunostaining and clinicopathologic features such as age, sex, tumor site, histologic subtype, osteoid content, osteoid pattern, pretreatment necrosis, pleomorphism of the cells, and presence of prominent nucleoli, except for mitotic activity per 10 HPF. P-glycoprotein positivity in immunohistochemistry should be taken into consideration to identify a subgroup of osteosarcoma patients with poor outcome at the time of diagnosis. So it might be an important marker in planning innovative chemotherapeutic regimens

[In vitro antimicrobial drug-resistance of urinary tract pathogens in patients admitted to Vali-E-Asr Hospital Wards]

Extensive use of antibiotics in medicine has led to resistance of microorganisms in urinary tract infection [UTI] in both children and adults. Therefore, conducting studies on antibiotic susceptibility is needed for selection of antibiotics based on regional studies. During the year 2006 urine samples from all symptomatic patients admitted to neonatal, pediatrics, obstetric and neurologic wards were collected through midstream clean-catch, catheterization, or urine bags. An antibiogram test was performed for all 118 urine samples which were culture positive. The most common organisms found in neonatal urine culture were klebsiella pneumoniae [44/5%] followed by Escherichia coli [33/5%]. Escherichia coli was the most common organism in pediatrics [41%], obstetric [46%], and neurologic wards [73%]. Resistance to ampicillin [82/6%] and cefixime [73/6%] was significant in all samples. Ciprofloxacine was the most effective drug against E.coli and klebsiella pneumoniae in all wards [resistance rate: 24/1%] followed by nitrofurantoin [resistance rate: 41/4%], ceftriaxone [resistance rate: 44/8%] and amikacin [resistance rate: 51/9%]. Vancomycin was the most effective drug against staphylococcus epidermidis [resistance rate: 37/1%] followed by cephtasidim [resistance rate: 40/1%] and ciprofloxacine [resistance rate: 48/5%]. Unfortunately due to irrational use of antibiotics, high resistance to ampicillin, cefixim, gentamycin, cotrimoxazol, and some other drugs was observed. Continuous studies regarding the drug resistance are recommended for better assessment in the future

Osteosarcoma arising from a solitary osteochondroma of the tibia

We present a case of osteosarcoma arising from an osteochondroma of the right tibia in a 71 year old man. The radiographic studies were suggestive of a malignant lesion. Histologic examination showed a conventional osteosarcoma that eroded the cartilagenous cap. The patient received postoperative chemotherapy with no evidence of metastasis until three years following the operation. The occurrence of osteosarcoma out of osteochondroma is an extremely rare event and very few cases have been reported

[Comparison between light and electron microscopic findings in 30 patients with lupus nephritis]

The kidney biopsy specimen is used for initial diagnosis of patients with SLE who at the time of biopsy lack either diagnostic clinical manifestation and or serological markers. Another role is evaluation of renal dysfunction in transplanted patients when lupus has occurred in renal allograft. The aim of this study is correlating the findings of light, immunofluorescent and electron microscopy in thirty patients with lupus nephritis. The kidney biopsies of thirty patients with SLE were studied for purpose of correlating the findings of light, immunofluorescent and electron microscopy. We studied 30 parameters in light microscopy sections, 5 parameters in semi -thin and EM sections, and IgG, IgM, IgA, C3, C4 and fibrinogen in different structures of specimens by immunofluroscent microscopy. The P value and measurement of agreement of kappa was calculated. In 25 cases LM and EM correlated completely including lupus nephritis class, activity and chronicity indices and presence or absence of immune complex deposition. In 5 cases discrepancy between Light Microscopy and Electron Microscopy diagnosis was found. Three cases were classified as class three according to LM and class two by EM. LM reevaluation of all three cases showed focal and segmental endocapillary cell proliferation with neutrophilic infiltration. We found that LM study is cornerstone in the focal lesions because of the limited inclusion of glomeruli in EM. One case of class four by LM, in EM shows massive [grade three] sub-epithelial depositions and grade one sub endothelial deposition and was classified it as Class five + six. In LM, findings cellular crescent in six glomeruli, severe endocapillary cell proliferation with activity index of [16/24] were detected. So the correct diagnosis was Class five + six. The last case classified as four in LM classification and revealed moderate mesangial cell proliferation with obliteration of lumens. In EM, we had three glomeruli which all showed mesangial cell proliferation, grade two mesangial deposition, with one focus of small [grade one] sub endothelial deposition. According to the above-mentioned findings the EM class of patient was class two. We found that there is agreement between EM and semi-thin sections for detection of exact site of depositions as well as their grading. Study of semi-thin sections by LM can demonstrate the deposits that are observed on EM

Blood transfusion acute reactions in patients of Shahid Ghazi Hospital

Cancer patients due to bone marrow suppression, sepsis, and other relevant complications require appropriate blood components for transfusion. However, there are risks of transfusion reactions. These reactions are influenced by many factors varying across different geographic regions and medical centers. This study was performed to determine incidence of early transfusion reactions and their clinical symptoms and signs in cancer patients, and to calculate the correlation of these adverse reactions with some demographic data and some specifications of blood components. In this descriptive study, 39 reactions from 4023 blood transfusion attempts were assessed. Patients were monitored for symptoms and changes in vital signs within 24 hours following transfusion. Data analysis was performed by descriptive and inferential statistics [X 2 and ANOVA].The majority of reactions belonged to platelets [56.43%] and packed cells [43.58%]. The most common symptoms were shown to be rigors [2.72%], and fever [2.33%]. The incidence rate was estimated to be 2.7% for FNHTR, and 2.1% for allergic reactions. Haptoglobin deficiency was found in 0.8% of FNHTR cases. A correlation was observed between sex and history of previous reactions [p=0.048, p=0.04, respectively] with blood transfusion reactions. These findings indicated that incidence of blood transfusion reactions and clinical symptoms correlated with other studies. The incidence of reactions in women and individuals with previous history of repeated blood transfusions was shown to be greater. Transfusion of packed cell was associated with allergic reactions [p=0.04], and high platelet lifetime associated with pulmonary reactions [p=0.044]

Making sense of grounded theory approach: implications for medial education research

This article first gives a definition of grounded theory and its development and use in medicine and medical education. The fundamental differences of grounded theory with quantitative methods are discussed along a full discussion of the steps required to use a grounded theory approach. At the end the questions in the area of medical education which can best addressed with this approach are provided

Polyclonal Ki-67 expression in transitional cell carcinoma of the bladder

Current methods of predicting prognosis in transitional cell carcinoma [TCC] of the bladder fail to provide consistently reliable information about future tumor behavior. The polyclonal antibody Ki-67 recognizes a nuclear antigen exclusively present in cells in the cell cycle. The Ki-67 reactivity has been shown to correlate with conventional prognostic indicators in several tumors.We studied the proliferative activity of 40 cases of transitional cell carcinomas of the bladder using polyclonal Ki-67 and determined the proportion of cells undergoing active division. A significant correlation was observed between cells with activated DNA [Ki-67], histological grading and staging [P< 0.0001]. The differences of mean Ki-67 index in the grade Ila versus lib [using Pauwell classification] was also significant [P<0.044]. Those cases which were limited to epithelial layer [stage Ta] show lower Ki-67 positivity than those infiltrating the lamina properia or deeper layers [stage Tl, T2, T3 and T4][P< 0.05]. The differences between stage Tl versus T2 and T3 versus T4 were not statistically significant [P>0.05]. The tumors with lymphatic and vascular invasion showed greater Ki-67 positivity than non-invasive tumors [P<0.01] These results suggest that the immunohistochemical assessment of the proliferative activity of transitional tumors of the bladder, using polyclonal antibody Ki-67 correlates with higher tumor stage and grade. Ki-67 staining provides an easy method of determining tumor cell turnover that might provides additional prognostic information. The results also indicate that the number of Ki-67 positive cells in grade II tumors may be useful aid in separating grade II TCC with favorable prognosis [Ila] from those with a poor clinical outcome [lIb]

Prevalence of unwanted pregnancy and multivariate analysis of its correlates in Tabriz city, 2004

Despite relatively easy access to contraceptive, the prevalence of unwanted pregnancy is high. The purpose of this study was to estimate the proportion of unwanted pregnancies and related factors among mothers delivering at 6 hospitals in Tabriz. In this cross-sectional study, 1576 women attended to 6 hospitals for delivery or abortion in September 2004 in Tabriz were interviewed. The questionnaire surveyed demographic characteristics, fertility history, contraceptive use, and willingness to pregnancy. The data were analyzed by multivariate logistic regression using SPSS and EPI software. Totally, 414[26.7%] women had unwanted pregnancy. Higher age [OR=1.06], higher number of live children [OR=1.37], and having history of unwanted pregnancy [OR=4.34] were associated with unwanted pregnancy. Unwanted pregnancy is quite common in the region, thus, appropriate policies should be considered to eliminate this maternal health concern

[Accuracy of fine needle aspiration in bone lesions]

To determine the accuracy of Fine Needle Aspiration [FNA] cytology in the diagnosis of bone lesions, fifty bone lesions after clinical and radiographic correlation were evaluated by FNA. The results were compared with the histopathology of the open biopsis. Accuracy rates of 75% and 88% were achieved by FNA of non-malignant and malignant bone lesions respectively. Chondrosarcoma and non-malignant lesions such as unicameral bone cyst gave the greatest diagnostic difficulties. Osteosarcoma, Ewing's sarcoma and metastasis could be easily identified when interpreted with clinical and radiographic findings. FNA plays an important role in early diagnosis of most of the malignant bone lesions. Cytologic evaluation together with clinical and radiographic findings has a high accrucy rate for diagnosis of bone lesions

Differentiation between bening, reactive and malignant cells in serosal body fluids by Ag NOR staining

Argyrophilic nucleolar organizer regions [AgNORs] were determined in 94 pleural, pericardial and peritoneal effusions. The results were correlated with cytologic diagnosis to determine the diagnostic potential of this technique. Cytologically the number of normal, reactive and malignant effusions were 32, 28 and 34 respectively. The mean AgNOR counts for normal, reactive and malignant specimens were 1.365, 2.328 and 4.747 respectively. The cut-off points between normal-reactive and reactive-malignant specimens were 1.84 and 3.53 respectively. All of the malignant specimens [100%] had AgNOR counts above 3.53. Neither reactive nor normal specimens had AgNOR counts above 3.53. 82.1% of reactive specimens had AgNOR counts above 1.84 and 87.5% of normal specimens had AgNOR counts below this point. There was a statistically significant difference between the AgNOR counts in normal, reactive and malignant effusions [p<0.001]. We conclude that the AgNOR method is a specific diagnostic tool for serosal cavity effusions, especially when malignancy is suspected

Metastatic ewing's sarcoma of the parotid gland, dagnosed by FNA cytology

Ewing's sarcoma can metastasize to many parts of the body, including bone, lungs, liver and lymph nodes. Metastasis to parotid gland, however, is unusual and has not been reported so far. This report describes clinical and cytological findings of Ewing's sarcoma, metastasizing to the parotid gland

Exfoliative cytology in the esophageal carcinoma

In this study, the results of endoscopic biopsy and exfoliative cytology in the diagnosis of esophageal carcinoma, are compared. Among one thousand cases clinically suspicious of, or at risk for esophageal carcinoma, 20 proved to be malignant on surgical specimen. Brushing cytology was positive in eighteen and biopsy, in seventeen cases. All of the negative cases [30] were diagnosed correctly by both cytology and biopsy [no false positive]. False negative cases in biopsy [3] were diagnosed by cytology and false negative cases in cytology [2 cases] were correctly diagnosed by biopsy. All benign and malignant cases were, therefore correctly diagnosed by combined cytology and biopsy. It is concluded that performing both esophageal biopsy and brushing cytology will improve the diagnostic accuracy without adding inconvenience to patient

Management of fractures in pyknodysostosis: a case report

Management of pathologic pycnodysostosis fracture of long bones with associated problems in a case of pycnodysostosis is reported. The clinical and pathologic findings are discussed