Expression of p27 and p53: comparative analysis of uterine carcinosarcoma and endometrial carcinoma.

The aim of the study was to assess both p27 and p53 expression in the stromal and epithelial component of carcinosarcoma and to assess if their expression in the latter is different than in endometrial carcinoma. Immunohistochemical staining for p27 and p53 was performed on paraffin-embedded tissue blocks of 18 uterine specimens with carcinosarcoma and their expression assessed. Their expression in the epithelial element was also compared to that in 35 paraffin-embedded tissue blocks of endometrial endometrioid carcinoma. Reduced p27 expression was observed in a similarly high proportion of the stromal (77.8%) as well as of the epithelial component (66.7%) of carcinosarcoma. Although statistically not significant, the proportion of reduced p27 expression in endometrial carcinoma (85.7%) was higher than in the epithelial element of carcinosarcoma. The percentage of p53 overexpression in both elements of carcinosarcomas and in endometrial carcinomas was low and also similar (27.8 and 20.0%, respectively). Our results indicate that reduced p27 expression is common and p53 overexpression is infrequent in carcinosarcoma. Their similar rates of expression in the stromal and epithelial elements of the tumor support the contention of a monoclonal origin of carcinosarcoma. Unexpectedly, reduced p27 expression is more common in endometrial carcinoma than in the epithelial element of carcinosarcoma, in spite of the less favorable prognosticators and outcome in the latter. Further studies of p27 expression in carcinosarcoma are indicated to establish its clinical value in this aggressive malignancy.

An introduction to the Barell body region by nature of injury diagnosis matrix.

INTRODUCTION: The Barell body region by nature of injury diagnosis matrix standardizes data selection and reports, using a two dimensional array (matrix) that includes all International Classification of Diseases (ICD)-9-CM codes describing trauma. AIM: To provide a standard format for reports from trauma registries, hospital discharge data systems, emergency department data systems, or other sources of non-fatal injury data. This tool could also be used to characterize the patterns of injury using a manageable number of clinically meaningful diagnostic categories and to serve as a standard for casemix comparison across time and place. CONCEPT: The matrix displays 12 nature of injury columns and 36 body region rows placing each ICD-9-CM code in the range from 800 to 995 in a unique cell location in the matrix. Each cell includes the codes associated with a given injury. The matrix rows and columns can easily be collapsed to get broader groupings or expanded if more specific sites are required. The current matrix offers three standard levels of detail through predefined collapsing of body regions from 36 rows to nine rows to five rows. MATRIX DEVELOPMENT: This paper presents stages in the development and the major concepts and properties of the matrix, using data from the Israeli national trauma registry, and from the US National Hospital Discharge Survey. The matrix introduces new ideas such as the separation of traumatic brain injury (TBI), into three types. Injuries to the eye have been separated from other facial injuries. Other head injuries such as open wounds and burns were categorized separately. Injuries to the spinal cord and spinal column were also separated as are the abdomen and pelvis. Extremities have been divided into upper and lower with a further subdivision into more specific regions. Hip fractures were separated from other lower extremity fractures. FORTHCOMING DEVELOPMENTS: The matrix will be used for the development of standard methods for the analysis of multiple injuries and the creation of patient injury profiles. To meet the growing use of ICD-10 and to be applicable to a wider range of countries, the matrix will be translated to ICD-10 and eventually to ICD-10-CM. CONCLUSION: The Barell injury diagnosis matrix has the potential to serve as a basic tool in epidemiological and clinical analyses of injury data.

Reconstructed measurements produced from ultrasound images using a computerized system.

OBJECTIVE: The aim of this study was to evaluate the feasibility and accuracy of reconstructed measurements produced from video-printed ultrasound images. DESIGN: Reproduction of reconstructed measurements using designated software and comparison of the results with regular measurements derived from the same images. SUBJECTS: Seventy regular sonographic examinations of biparietal diameter (BPD) and nuchal translucency (NT) thickness. METHODS: The study included 35 conventional-size (BPD) and 35 small-size (NT) measurements. Each image was measured twice during a dynamic ultrasound examination (regular measurements) and twice using a computerized system (reconstructed measurements). The latter comprised three steps: (i) computerization (computer-generated images by scanning); (ii) calibration (using the scale located alongside the image); (iii) measurement (placing the calipers at the desired points). RESULTS: All images were successfully scanned, and the computer-generated images were of sufficient quality for proper measurement. There was no difference between mean values of regular and reconstructed BPD measurements, 63.9 mm (3.7 mm, SE) and 63.6 mm (3.8 mm, SE), respectively. Similarly, mean values of regular NT measurements were similar to the reconstructed ones, 1.48 mm (0.09 mm, SE) and 1.49 mm (0.09 mm, SE), respectively. Repeated regular BPD and NT measurements exhibited repeatability coefficients of 1.6 mm and 0.4 mm, respectively. These values were smaller than those obtained by repeated reconstructed measurements of 2.1 mm and 0.52 mm, respectively. CONCLUSIONS: Reconstructed measurements of ultrasound video-printed images are feasible, require modest facilities and exhibit more than reasonable accuracy. This option may contribute to medical research, audit, quality control and training, as well as to medico-legal issues.

Mortality epidemiology in low-intensity warfare: Israel Defense Forces' experience.

PURPOSE: an analysis of the mortality epidemiology in low-intensity warfare. BASIC PROCEDURES: we retrospectively reviewed all cases of Israeli soldiers killed in small-scale warfare during 1996-1998, using field data, hospital charts and autopsy reports. Data on injury pattern, offending munitions and time of death were analyzed. MAIN FINDINGS: in the study period, 106 soldiers were killed. Penetrating trauma was the common injury mechanism (95%) most frequently due to claymore bombs and gunshot bullets. The percentage dying in the prehospital phase and in the first 30-min were 77 and 88%, respectively. The average injury severity score (ISS) was 42.5. Seriously injured body regions were thorax (38%), head (24%), abdomen and pelvis (13%) and neck (12%). CONCLUSIONS: there is no trimodal death distribution in military trauma. Most casualties of low-scale conflicts die very early after injury. Most fatal injuries involve the head and trunk regions. The distribution of injury depends on the type of assaulting munitions.

Torsion of single normal adnexa in a premenarchal girl.

A 9-year-old girl had torsion of a normal adnexa. She also had absence of the contralateral adnexa, most probably due to undiagnosed ovarian torsion.

Preliminary experience with postmortem computed tomography in military penetrating trauma.

BACKGROUND: Postmortem examination serves as a tool for confirmation of clinical diagnosis, "quality" assurance, and education. In Israel, mostly because of religious reasons, most families withhold their permission to perform autopsies. To obtain objective information regarding the death of soldiers, the Israel Defense Forces Medical Corps started in September of 1997 to perform postmortem computed tomographic (PMCT) scans. The purpose of our study is to determine what information can be obtained from the PMCT scans. METHODS: In a period of 16 months, 27 soldiers were killed in low-intensity conflicts and PMCT was obtained in 22 cases. Medical data obtained from the field medical care providers were collected and compared with PMCT results. RESULTS: Several examples of patients whose death was determined at the scene either before any medical intervention or after initiation of resuscitative treatment are shown in our study and compared with the clinical impression of the treating physician. Two examples of autopsy results are compared with PMCT results. Gas was detected in various parts of the circulatory system in many cases. The significance of this finding, described in our study for the first time, needs further investigation. CONCLUSION: PMCT scanning has limits in detecting superficial injuries and injuries of the extremities and determining the exact route of fragments through body tissues in penetrating military trauma. It also cannot serve as a tool for examining ammunition or the protection provided by various armors. However, it can provide a substantial amount of evidence that, when reviewed with the clinical information obtained from the physician at the scene, can help in assessing the treatment given at the field and point toward the probable cause of death.