Solid cystic pseudopapillary tumor of the pancreas in children: A case series

Solid cystic pseudopapillary tumor (SCPT) of the pancreas is rare and is difficult to diagnose pre-operatively. We describe four children with abdominal pain and abdominal mass who were diagnosed with SCPT. Three underwent resection of the mass, one an open liver biopsy. Histopathology showed solid epithelioid cells, cystic areas, and pseudopapillary structures. SCPT is a low-grade malignant tumor with good prognosis and should be suspected in any child with an abdominal mass and abdominal pain.Key Words: Solid cystic pseudopapillary tumor, pancreas

Primary pulmonary Epithelioid Trophoblastic tumor co-existing with Choriocarcinoma / Philippine Journal of Obstetrics and Gynecology

@#A 28-year old, G5P4 (4014), noted neck lymph nodes associated with cough. A chest X-ray was done showing a left nodular opacity. Antibiotics were prescribed with a resolution of symptoms. Five months after, a routine chest X-ray revealed interval progression in size of the lung nodule. A chest computed tomography (CT) scan and positron-emission tomography scan were done subsequently showing the precise location and size of the nodule and with no other focus of tumor seen. Transvaginal ultrasound was normal. With an initial diagnosis of lung carcinoma, a percutaneous needle aspiration biopsy under CT scan guidance was done. Immunohistochemical staining panel showed that beta-human chorionic gonadotropin (hCG) was positive. Subsequently, a serum beta-hCG done showed low levels from 33.48 to 59.7 mIU/ml. The final diagnosis given was a poorly differentiated malignancy highly suggestive of malignant trophoblastic tumor. A video-assisted left upper lobectomy was performed with histopathology and immunohistochemistry consistent with epithelioid trophoblastic tumor with co-existing choriocarcinoma elements. Postoperative beta-hCG level dropped to normal and remained so for 2½ years.

Comparison between Ozurdex and intravitreal anti-vascular endothelial growth factor treatment for retinal vein occlusion–related macular edema: A systematic review and meta-analysis of randomized controlled trials

This systematic review aimed to evaluate the effectiveness and safety of intravitreal dexamethasone (DEX) implant and intravitreal anti-vascular endothelial growth factor (VEGF) treatments for macular edema (ME) secondary to retinal vein occlusion (RVO), central retinal vein occlusion (CRVO), and branch retinal vein occlusion (BRVO). The electronic databases comprehensively searched for the studies that compared DEX with anti-VEGF treatments in patients suffering from RVO-related ME. The effectiveness was estimated using best-corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP). All data were analyzed by Review Manager (RevMan) 5.3. According to the meta-analysis from five randomized control trials, both DEX implant and anti-VEGF agent treatments were effective, but no significant differences in BCVA and CRT were observed between these two treatments. Novartis' two studies indicated that anti-VEGF agents significantly reduced the CRT compared with DEX implant at 6 months [weighted mean difference: 158.53 ?m, 95% confidence interval (CI): (71.09, 245.96), P= 0.0004]. Furthermore, anti-VEGF agents showed some advantages on cataract formation [risk ratio (RR): 3.43, 95% CI: (1.35, 8.71), P= 0.009] and other adverse events [RR: 1.19, 95% CI: (1.09, 1.31), P= 0.0002] without heterogeneity (P = 0.20, I2 = 35%). Anti-VEGF agents were also effective treatments for cataract formation or less adverse events for RVO-related ME. In contrast, DEX implant had higher risk for IOP elevation and lower cataract incidence than anti-VEGF agents. Hence, complementary and alternative treatments are expected.

Meristic and morphometric analysis of two hagfish species (Myxine affinis and Notomyxine tridentiger) from the Magellan Strait, Chile / Análisis nerístico y morfométrico de dos especies de anguila babosa (Myxine affinis y Notomyxine tridentiger) en el Estrecho de Magallanes, Chile

Myxinoids in Chile are represented by the subfamilies Eptatretinae and Myxininae, with a total of 14 species, the identification is complex due to the low level of morphological differentiation that characterizes this taxonomic group. Worldwide, hagfish are species of commercial value, and in Chile many attempts have been reported to initiate small-scale fisheries. The aim of the present study is describe the hagfish species caught in an incipient fishery of the Magellan Strait. Samples were collected in the Magellan Strait during eight fishing expeditions from June 2009 to October 2010 in Bahía Lomas (5348`S; 70°46'W) and Agua Fresca (5323`S; 70°45'W). The samples were taken at two depths, 0-70 meters and 71-140 meters. Taxonomic keys were used to identify the species. All specimens were individuals from the Myxininae subfamily. From a total of 3946 hagfishes, 99 % (n=3905) were the species Myxine affinis and the remaining 1 % were Notomyxine tridentiger, both reported for Chilean and Argentinean Patagonia. The range of variation for meristic variables recorded in this research was wider than those reported in the literature. This could be explained by differences in sample size between the present study and those previously published. Body proportions and meristic variables were not species specific in Myxine sp, so there is a large overlap of ranges between species, which makes their diagnostic use not applicable. This research updates the information and extends the meristic ranges for both species. The esophageocutaneous duct (in N. tridentiger) and the number of fused teeth (bicuspid in M. affinis and tricuspid in N. tridentiger) are the morphological characters that allow a clear identification in the field of the two species.

Los Myxinoideos en Chile están representados por las subfamilias Eptatretinae y Myxininae, con un total de 14 especies, cuya identificación resulta compleja debido al bajo nivel de diferenciación morfológica que caracteriza a este grupo taxonómico. A nivel mundial las anguilas babosas constituyen especies de valor comercial, y en Chile se reportan varios intentos para iniciar pesquerías de pequeña escala. El presente estudio tuvo como propósito la descripción de las especies de anguila babosa capturadas en una pesquería incipiente del Estrecho de Magallanes. Los ejemplares fueron colectados durante ocho expediciones de pesca, desde junio de 2009 a octubre de 2010 en Bahía Lomas (5348`S; 70°46'W) y Agua Fresca (5323`S; 70°45'W). Las muestras fueron tomadas en dos rangos de profundidad, 0-70 metros y 71-140 metros. Todos los especímenes fueron pertenecientes a la subfamilia Myxininae. De un total de 3946 anguilas el 99 % (n=3905) pertenecieron a la especie Myxine affinis y el restante 1 % a la especie Notomyxine tridentiger, ambas reportadas para Chile y la Patagonia Argentina. El rango de variación para las variables merísticas, registradas en esta investigación, fue mayor a los reportados en literatura. Esto puede ser explicado por las diferencias en el tamaño de muestra entre el presente estudio y aquellos publicados previamente. Las proporciones corporales y las variables merísticas no fueron especie-específica en Myxine sp, por lo que existe una gran sobre posición de los rangos entre las especies, lo que hace que su uso como diagnóstico no sea aplicable. Esta investigación actualiza la información y extiende los rangos merísticos para ambas especies. El conducto esofágico-cutáneo (en N. tridentiger) y el número de dientes fusionados (bicúspide en M. affinis y tricúspide en N. tridentiger), son los caracteres morfológicos que permiten una identificación clara de ambas especies.

Protective effects of tumor necrosis factor-α blockade by adalimumab on articular cartilage and subchondral bone in a rat model of osteoarthritis

We aimed to investigate the effects of an anti-tumor necrosis factor-α antibody (ATNF) on cartilage and subchondral bone in a rat model of osteoarthritis. Twenty-four rats were randomly divided into three groups: sham-operated group (n=8); anterior cruciate ligament transection (ACLT)+normal saline (NS) group (n=8); and ACLT+ATNF group (n=8). The rats in the ACLT+ATNF group received subcutaneous injections of ATNF (20 μg/kg) for 12 weeks, while those in the ACLT+NS group received NS at the same dose for 12 weeks. All rats were euthanized at 12 weeks after surgery and specimens from the affected knees were harvested. Hematoxylin and eosin staining, Masson's trichrome staining, and Mankin score assessment were carried out to evaluate the cartilage status and cartilage matrix degradation. Matrix metalloproteinase (MMP)-13 immunohistochemistry was performed to assess the cartilage molecular metabolism. Bone histomorphometry was used to observe the subchondral trabecular microstructure. Compared with the rats in the ACLT+NS group, histological and Mankin score analyses showed that ATNF treatment reduced the severity of the cartilage lesions and led to a lower Mankin score. Immunohistochemical and histomorphometric analyses revealed that ATNF treatment reduced the ACLT-induced destruction of the subchondral trabecular microstructure, and decreased MMP-13 expression. ATNF treatment may delay degradation of the extracellular matrix via a decrease in MMP-13 expression. ATNF treatment probably protects articular cartilage by improving the structure of the subchondral bone and reducing the degradation of the cartilage matrix.

Evaluación del tratamiento intensificado con conteo de hidratos de carbono en un grupo de niños con diabetes tipo 1 / Evaluation of treatment intensified with carbohydrate counting in a group of children with diabetes type 1

Introducción. Los resultados del Diabetes Control and Complications Trial (DCCT) demostraron que con la terapéutica intensificada, se logra mejorar el control glucémico, retrasando la aparición de complicaciones crónicas de la diabetes. Objetivo. Comparar el control metabólico en un grupo de niños con diabetes tipo 1 (DM1) seguidos en el Hospital Sor María Ludovica según el esquema utilizado: Tratamiento Convencional (TC) versus Tratamiento Intensificado (TI) con educación en Conteo de Hidratos de Carbono (CHC).Materiales y método. Estudio clínico comparativo, prospectivo, descriptivo y analítico en dos grupos: TI y TC. Se evaluó la edad cronológica al debut (EC), talla (T), Índice de Masa Corporal (IMC) según curvas OMS, tiempo de evolución de la diabetes e insulinas utilizadas. Se analizaron las insulinas utilizadas en cada grupo y las modificaciones en el IMC, Hemoglobina Glicosilada (HbA1C), y la presencia de hipoglucemias severas a los 6 meses del CHC.Resultados. La media de HbA1C al inicio fue de 10.11 ± 2.51% y a los 6 meses 8.10 ± 1.77% en TI, disminuyó 2.01% (p<0.0001). En TC la HbA1C al inicio fue de 8.86 ±1.87% y a los 6 meses de 9.78 ± 2.18%, aumentó un 0.92% (p=0.0002).Discusión. Los resultados muestran que el TI en niños puede llevarse a cabo logrando una reducción de la HbA1C sin aumentar las hipoglucemias y otros efectos adversos.

Understanding current attitudes in HER2 testing for breast cancer at tertiary referral hospitals of Metro Manila, Philippines

INTRODUCTION: The difficulty of obtaining accurate and reproducible assessment of HER2 status in the Philippines, despite the predictive value of the test for HER2 positive breast cancer patients, may be sufficiently addressed if an effective multidisciplinary approach to HER2 testing is carried out. This may be accomplished by identifying disparities and similarities in HER2 testing for breast cancer.METHODS: This is a cross-sectional study which included medical oncologists who had used trastuzumab for HER2-positive patients. Surgeons, who belonged to the same tertiary hospital as the medical oncologists were also interviewed. The survey questionnaires were administered via face-to-face, mail, or fax. Responses were kept confidential. Questionnaire responses were analysed using summary statistics.RESULTS: There were 35 medical oncologists and 37 surgeons - 93% stated that all women diagnosed with breast cancer should be tested for HER2 at the point of diagnosis; 61% stated that the greatest barrier to initiating HER2 testing was inadequate patient funds. 57% medical oncologists and 65% surgeons believed that HER2 testing for all breast cancer patients at the point of clinical diagnosis was being observed at their hospital. 69% stated that medical oncologists or surgeons should request for HER2 test whoever saw the patients first; 59% stated that whoever saw the patient first provide the patient information about HER2 testing whereas 28% stated it is the medical oncologist who should provide information about HER2 testing. 47% medical oncologist and 63% surgeons stated that surgeons should arrange for breast tissue sample collection; 27% medical oncologists and 20% surgeons stated that pathologists should do this.CONCLUSION: Medical oncologists and surgeons were similar in the opinion that all women diagnosed with breast cancer should be tested for HER2 at the point of diagnosis, financial capability was the greatest barrier for initiating HER2 testing, and whoever saw the patient first should provide patient education. There was disparity on who should request and who should arrange for tissue collection.

Specimen handling and tissue preaparation in pre-analytical phase of HER2 testing at tertiary referral hospitals of Metro Manila

INTRODUCTION: HER2 test result depends on a good quality histological section of the breast specimen. Laboratories that process specimens using sophisticated and molecular testing should receive suitable specimen for more accurate results and less waste of expensive resources.METHODS: A questionnaire based on the ASCO-CAP Guidelines for HER2 testing was developed and administered to pathologists from the local laboratories of Metro Manila-Philippines tertiary referral hospitals. Questionnaire responses were analyzed using descriptive statistics.RESULTS: Most laboratories did quality control/quality assessment monitoring for the pre-analytic, analytic,post-analytic and turn¬around time phases. Many transported their specimens from the operating room to the laboratoryCONCLUSION: Even in standardized procedures, small variations in sample processing for IHC and FISH can still occur. Inexperienced laboratories will have greater problems interpreting HER2 status results. Laboratories should look into their system in handling specimens for an accurate HER2 testing towards quality assurance.

Histological pattern and outcome of Filipino children with liver disease who underwent percutaneous liver biopsy: A five year survey

BACKGROUND: Histological assessment is important in evaluating liver disease. We determined the clinical diagnose and predominant histological patterns of children with liver disease and association of histological pattern with outcome. METHODS: Consecutive patients RESULT: 470 cases (1month-18years; 65% males; 85% CONCLUSION: Most common clinical diagnoses were neonatal hepatitis and biliary atresia. Predominant histological patterns were giant cell and obstructive type. Histological patterns of giant cell hepatitis seen in neonatal hepatitis resulted in better outcome.

Patologías bucales en niños y adolescentes: estudio restrospectivo de veinte años / Oral diseases in children and adolescents: twenty-year retrospective study

Este estudio pretende determinar la prevalencia de la patología bucal y maxilofacial en niños y adolescentes de 0 a 16 años, diagnosticados en un centro de referencia para el cáncer en São Luís - MA en un período de 20 años. Los datos fueron recogidos de los casos diagnosticados en el Departamento de Patología, Instituto de Oncología Maranhense Aldenora Bello - IMOAB 1985 y 2005. Los datos recogidos fueron sexo, edad del paciente al momento del diagnóstico, región anatómica afectada y el diagnóstico histopatológico. Se encontró que la patología de los tejidos blandos benignos fueron los más frecuentes, representando el 41,52% de toda la patología maxilofacial en niños y adolescentes, y las lesiones más comunes fueron: granuloma piógénico (14,44%), proceso inflamatorio crónico (12,9%) y Hemangioma (11,55%), y la prevalencia anatómica de los labios. Entre los casos de tumores malignos (10,83%), los más prevalentes fueron Linfoma de Hodgkin (2,16%), Linfoma no Hodgkin (2,16%), tumores malignos no identificados (2,16%) y sarcoma (1,44%). En cuanto al sexo, hubo una mayor frecuencia de trastornos en los pacientes de sexo masculino (55,76%), excepto para el grupo de enfermedades de la piel, que eran más comunes en las mujeres. Basado en la metodología de los autores concluyeron que los casos benignos más frecuentes en niños y adolescentes de 0 a 16 años, convertirse en tumores malignos en el cuarto lugar

Tear and ocular surface profile in adult anophthalmic sockets

Objective@#To determine the tear and ocular surface profile of the anophthalmic socket in relation to the contralateral normal eye.@*Methods@#Twenty-five adult patients with unilateral anophthalmic sockets were included into the study. They were at least 2 months post-enucleation or post-evisceration and without any topical medications on the anophthalmic socket and control eye for at least 2 weeks. Assessment was performed using the following parameters: (1) meibomian gland evaluation, (2) ocular surface staining, (3) degree of conjunctival inflammation, (4) Schirmer I and II, and (5) conjunctival impression cytology. @*Results@#Mucoid discharge (52%) was the most common complaint in anophthalmic sockets, followed by itchiness (40%), tearing (36%), and dryness (4%). Compared to control eyes, the anophthalmic sockets had more pronounced and statistically significant lid wiper epitheliopathy, conjunctival staining, and bulbar inflammation. Meibomian gland dysfunction, Schirmer I and II, and conjunctival impression cytology showed no difference between the 2 groups. There was a correlation between the symptoms complained and the ocular staining patterns of the anophthalmic sockets.@*Conclusion@#Anophthalmia predisposes to various ocular surface problems, such as a change in the composition of tears, specifically an increase in the mucin component and a decrease in the aqueous and lipid components, resulting to increased tear viscosity.

Molecular genetic profiling of Filipino patients with retinoblastoma: A preliminary study

Objective@#To detect and characterize retinoblastoma susceptibility gene (RB1) mutations in tumor samples collected from Filipino patients with retinoblastoma.@*Methods@#Six tumor samples were obtained from Filipino patients diagnosed with retinoblastoma. DNA was extracted from the tumor samples and exons 13-21 of the RB1 gene were amplified by polymerase chain reaction (PCR). PCR amplification products were subsequently purified and sequenced. Mutation detection and characterization were done by alignment of obtained sequences to the RB1 reference sequence from NCBI GenBank using Bioedit® software. The identified mutations were correlated with clinical presentation and family history. These mutations were also compared to known mutations reported in the RB1 Gene Mutation Leiden Open Variation Database (LOVD).@*Results@#Mutations were detected in two out of the six samples. In a patient with unilateral disease and no family history, two mutations were identified: a novel CGT>AGT (Arginine → Serine) missense mutation in position c.1861 of exon 19 and a previously reported CGA>TGA (Arginine → STOP) nonsense mutation in position c. 1735 of exon 18. A possible large exonic deletion was identified in a case of unilateral disease with no family history.@*Conclusion@#We were able to identify both novel and known mutations in the RB1 gene of Filipino retinoblastoma cases using DNA sequencing techniques. These techniques may be applied to further characterize the genetic mutations of Filipino retinoblastoma cases and their families in developing a rational method of genetic testing for early diagnosis and counseling.

A vision to remember

@#On May 1911, the Department of Eye, Ear, Nose, and Throat (EENT) of the Philippine General Hospital (PGH) was established under the able leadership of Dr. Reinhart Remebe. As part of its commitment to pursue excellence and unconditional service, the graduates of what was then the Philippine Medical School (now the University of the Philippines College of Medicine (UPCM)) had to undergo a month of comprehensive training as an orientation to the department.

Técnicas de acesso cirúrgico vascular destinadas à monitoração invasiva em cães / Técnicas de acceso quirúrgico vascular para el monitoreo invasivo en perros / Surgical vascular access techniques for the dog invasive monitoring

A monitoração é essencial durante os procedimentos anestésicos, e pode ser realizada por métodos invasivos ou não-invasivos. A monitoração invasiva é obtida mediante a colocação de instrumentos no interior do corpo do animal, principalmente em vasos sanguíneos. Desse modo, objetivou-se com este estudo apresentar técnicas de abordagem cirúrgica vascular destinadas a monitoração invasiva em cães, descrever os acessos dos principais vasos sanguíneos, como as artérias femoral, safena medial, carótida comum, metatársica e sublingual e das veias jugular externa, femoral e safena medial e revisar os materiais necessários para a canulação destes vasos, bem como, as principais complicações dessas técnicas de abordagem cirúrgica.

Monitoring is essencial during anhestesic procedures, and can be performed by invasive or non-invasive methods. Invasive monitoring is anchieved with the insert of instruments inside the animal body, mainly in blood vessels. Thus, it was aimed with this study to present techniques of vascular surgical approach for invasive monitoring of dogs, describe the access of the main blood vessels, as the femoral artery, medial saphenous artery, carotid artery, metatarsal artery and sublingual artery, and the extern jugular vein, femoral and saphenous veins. Besides, the materials needed for vessel canulation are revised, and also the main complications of these surgical approach techniques.

El monitoreo es esencial durante los procedimientos anestésicos, y puede realizarse por métodos invasivos o no-invasivos. El monitoreo invasivo se logra mediante la colocación de instrumentos en el interior del cuerpo del animal, principalmente en vasos sanguíneos. Así, se buscó con este estudio presentar técnicas de abordaje quirúrgica vascular destinadas al monitoreo invasivo en perros, describir los accesos de los principales vasos sanguíneos, como las arterias femoral, safena medial, carótida común, metatársica y sublingual y de las venas yugular externa, femoral y safena medial, también revisar los materiales necesarios para canulación de estos vasos, así como las principales complicaciones de esas técnicas de abordaje quirúrgica.

Preseptal and orbital cellulitis at the Philippine General Hospital

OBJECTIVE: To describe the clinical features, causative agents, management practices, and outcomes of preseptal and orbital cellulitis at a tertiary-care center in a developing country. METHODS: This is a retrospective case series of preseptal and orbital cellulitis seen at the Orbit Clinic of the Philippine General Hospital from January 1990 to December 1995. The medical records were reviewed and the following data obtained: age, gender, manner of disease presentation, causative agent, medical interventions, and outcomes. RESULTS: Fifty-six patients with preseptal cellulitis and 35 with orbital cellulitis were identified. Among the patients with preseptal cellulitis, the mean age at presentation was 12.6 +/- 17.0 years. No gender predilection was observed. The most common presenting signs were lid swelling (all patients), eye redness (34 %), fever (29%), and eye discharge (27 %). Bilateral involvement occurred in 9 patients. Among those with orbital cellulitis, 25 were classified as orbital cellulitis, 5 as orbital abscess, and 5 as cavernous sinus thrombosis. There were slightly more females than males (1.3:1). The mean age at presentation was 17.1 +/- 18.6 years. The most common symptoms were lid swelling (94 %), ophthalmoplegia (89 %), chemosis (77%), proptosis (71%), and decreased vision (51%). Both conditions were associated with antecedent infectious conditions such as skin and lid infection, sinusitis, dental abscess, respiratory-tract infection, and trauma. Staphylococcus was the most common organism isolated. The most common initial antibiotics used were beta-lactamase-resistant penicillins. Other antibiotics were added based on clinical response and microbial studies. Orbital cellulitis was associated with sight threatening complications such as glaucoma, retinal vascular occlusion, exposure keratitis, and optic-nerve compression. CONCLUSIONS: The etiology of preseptal and orbital cellulitis in this series differs from that in developed countries. Preseptal and orbital cellulitis should be distinguished early so that proper management can be instituted. Orbital cellulitis is associated with greater mortality and morbidity. CT scan and microbial studies are invaluable for appropriate diagnosis and management of orbital cellulitis.

Etiología cromosómica de la esterilidad e infertilidad masculina / Chromosomic etiology of masculine sterility and infertility

Avances recientes en el conociminto del desarorollo sexual se han logrado al estudiar individuos con gónadas disgenéticas y alteraciones del aparato reproductor. Utilizando sondas Y-ADN en estos pacientes se ha encontrado que un gen de los brazos cortos del cromosoma Y, induce la diferenciación testicular. La forma como este gen actúa no se conoce, pero la observación de que existen secuencias homólogas en X y Y sugiere la posibilidad de que la diferenciación sexual depende de dosis génicas. Otros genes como el que codifica para el antígeno H-Y, el de la maduración esquelética, el crecimietno corporal, el tamaño dental y la regulación de la espermatogénesis se han identificado en el cromosoma Y. Hallazgos que han permitido un mejor entendimiento de los factores genéticos y citogénicos involucrados en la esterilidad-infertilidad.

Serologic study of toxoplasmosis in Taiwan.

Toxoplasma gondii antibody titers as determined by either the indirect hemagglutination test or the methylene blue dye test were determined for a group of aborigines and for Chinese as well as for swine, cats, rats, dogs and one bovine, all resident on the island of Taiwan. None of the 194 aborigines and only 3 (1.97%) of the 152 Chinese were found to be positive. Of 433 swine tested 132 (30.5%) were positive. Thirteen (27.7%) of 47 domestic pet cats were positive while none of 11 feral cats were positive. None of the 29 rats, 3 dogs or the one bovine were positive. Possible reasons for the lack of infection in Chinese is discussed.