Beta-catenin expression in benign and malignant pilomatrix neoplasms.

BACKGROUND: Beta-catenin is a 92-kDa protein, initially identified as a coprecipitating species with the E-cadherin cell-cell adhesive complex. It plays a role in signal transduction in the Wnt signalling pathway and has been identified as an oncogene in colon cancer and melanoma. Exon 3 beta-catenin-activating mutations were found in 75% of cases of pilomatricoma (PM). Previous studies have shown that nuclear and/or cytoplasmic staining may correlate with beta-catenin gene mutation. OBJECTIVES: Because the immunohistochemical expression of beta-catenin in the nucleus or the cytoplasm correlates with beta-catenin mutation, we studied the immunohistochemical profile of beta-catenin expression in normal scalp hair follicles and in PM and pilomatrix carcinoma (PC). METHODS: We reviewed 21 cases of PM and five cases of PC using immunohistochemical staining with commercially available antibody in a standard fashion on formalin-fixed paraffin-embedded tissue samples. RESULTS: All 26 tumours displayed both nuclear and cytoplasmic staining in the basaloid cells with focal membranous staining. Shadow cells were negative in all tumours. Normal control sections from the scalp displayed nuclear reactivity of the matrical cells, mostly concentrated in the supramatrical zone of hair follicles. Membranous staining was present along the intercellular junctions of the epidermis and along the outer and inner root sheaths of hair follicles. We have found similar patterns of beta-catenin nuclear and cytoplasmic expression in both PM and PC. CONCLUSIONS: Despite the shared beta-catenin expression, the biological behaviour of PM and PC is markedly different. These two tumours probably share the activation of a common cellular pathway that could be related to their shared method of keratinization or a shared dysfunction of the cellular adhesion complex and consequently tumorigenesis. To the best of our knowledge, this is the first report on the beta-catenin immunohistochemical expression profile in PC.

Postpartum angiographic embolization for vulvovaginal hematoma. A report of two cases.

BACKGROUND: Puerperal hematomas can become a life-threatening obstetric emergency. Their incidence is 1 or 2/1,000 deliveries. When mainstay methods of suture and packing fail, arterial embolization becomes an excellent alternative to definitive treatment, laparotomy. CASES: A 32-year-old woman, para 2-0-2-2, developed extreme rectal and vulvar pain one hour postpartum. A 12 x 10-cm vulvovaginal hematoma was identified, drained, sutured and packed. Bleeding continued, blood products were administered, and selective angiographic embolization of the pudendal and inferior gluteal arteries was successfully performed. A 31-year-old woman, para 1-0-1-1, developed a left vaginal hematoma immediately postpartum. She failed vaginal packing and underwent angiographic arterial embolization successfully. The patient was discharged on the fourth postpartum day. At six weeks postpartum, neither patient had evidence of hematoma formation. CONCLUSION: In the setting of a puerperal hematoma refractory to conventional first-line therapy, arterial embolization provides a rational, effective alternative for achieving hemostasis with minimal morbidity.

Fine-needle aspiration as the initial diagnostic modality in malignant lung disease.

Cytologic detection of lung cancer is accepted, accurate, and time-honored. Typically, cytologic workup of a radiologic abnormality proceeds sequentially from sputum to bronchoalveolar cytology, and, if necessary, to fine-needle aspiration biopsy (FNA). Initial use of FNA in lung cancer diagnosis is controversial, but increasingly popular. We therefore decided to objectively assess current practice in cytologic lung cancer diagnosis at our institution. All pulmonary cytologic diagnoses for 1993 and the first half of 1994 were retrieved. Positive diagnoses were then used to access all patient data. Patients were stratified according to the specimen from which the first positive diagnosis was obtained. Of 542 pulmonary cytology specimens, 15% were sputa, 65% were bronchoalveolar, and 20% were FNAs. One hundred sixty-one of 172 malignant diagnoses were first diagnoses. Three percent of first malignant diagnoses were made from sputa, 47% were from lavages, and 50% were from FNAs. Although FNAs comprised just 20% of all pulmonary cytologies, 50% of all new malignant cytologic diagnoses were made by FNA. Initial use of FNA is successful, has a high diagnostic yield and low complication rate, and offers the most direct approach to diagnosis.

Early restenosis following percutaneous transluminal balloon angioplasty for the treatment of the superior vena caval syndrome due to pacemaker-induced stenosis.

Superior vena caval syndrome (SVC) following transvenous pacemaker insertion is an uncommon complication that has been treated with percutaneous transluminal balloon angioplasty. We report a case of SVC syndrome following pacemaker implantation that was treated with angioplasty. Several days after the initial balloon dilation, the patient had recurrent symptoms and evidence of restenosis on catheterization. Following repeat balloon dilation of this restenotic lesion, the patient had a favorable clinical response evidenced on hemodynamic and angiographic follow-up at 6 months.

Left ventricular segmental volume by conductance catheter and Cine-CT.

The ability of the conductance catheter method to measure left ventricular segmental and total volume was evaluated by comparison with the Cine-CT technique. In the seven dogs studied, 19 conductance catheter and simultaneous Cine-CT runs were obtained. High correlation coefficients were found for total volume and segmental volumes, except in the basal segment. However, in most cases there was a significant variability in slope and intercept between animals. Both methods are promising tools for estimating dynamic segmental left ventricular volume, each having specific advantages such as a continuous signal (conductance catheter) or anatomic detail (Cine-CT). However, the results also show the need for further improvement of both methods.

Relapsing polychondritis: a case diagnosed by direct immunofluorescence and coexisting with pseudocyst of the auricle.

A case of relapsing polychondritis with perichondrial IgG and C3, dermoepidermal IgG, and a coexisting pseudocyst of the auricle is reported. The use of direct immunofluorescence testing in establishing a diagnosis of relapsing polychondritis and the expected findings are reviewed. In some cases direct immunofluorescence may allow a diagnosis of relapsing polychondritis before clinical criteria or a routine histologic evaluation suggests a definite diagnosis.

PUVA therapy.

PUVA is an acronym for psoralen plus ultraviolet-A radiation. This form of photochemical therapy is commonly used in the treatment of psoriasis and vitiligo, but it is also beneficial in other dermatologic diseases. An understanding of psoralen's mechanism of action and the unique properties of the various psoralen preparations is important in ensuring optimal results with this therapy.

Mucocutaneous presentations of Crohn's disease.

Crohn's disease is an idiopathic inflammatory process that predominantly affects the gastrointestinal tract. Numerous extraintestinal manifestations of Crohn's disease involving the skin and mucous membranes have been reported in patients with documented intestinal disease. We report here on two patients who presented with multiple manifestations of Crohn's disease before intestinal disease was diagnosed. We review the mucocutaneous manifestations of Crohn's disease with an emphasis on presentations that precede gastrointestinal involvement.

The role of interventional radiology in the management of genitourinary trauma.

The role of the radiologist in the management of urologic disease has changed dramatically in the last 10 years with the introduction of new imaging methods and the evolution of the angiographic catheter into a therapeutic instrument. The authors review the diagnostic options in genitourinary trauma, the indications for and techniques of transcatheter arterial embolization for renal and other retroperitoneal hemorrhage, and nonvascular interventions such as antegrade nephrostomy, stenting of urethral disruptions, percutaneous bladder drainage, and drainage of abscesses, hematomas, and urinomas.

Axillary and subclavian vein stenosis: percutaneous angioplasty.

Twenty-nine percutaneous balloon dilations of the axillary and subclavian veins were performed in 19 patients. Stenoses occurred in typical locations of anatomic narrowing or at sites of previous trauma. The initial success rate was 76%, with a 1-year patency rate of 35% and a 2-year patency rate of 6%. Angioplasty can be performed on an outpatient basis with a very low rate of significant complications and can be repeated numerous times to keep a vein patent for many years. This procedure is especially valuable in dialysis patients who have limited access sites.

Transplantation of human basal cell carcinoma to C57/BALB/C bgJ/bgJ-nu/nu (beige-nude) mouse.

The purpose of this study was to evaluate the transplantation of BCC to the C57/BALB/C bgJ/bgJ-nu/nu (beige-nude) mouse. This animal has two gene defects which are expressed as impairment of natural killer cells (NK cells) as well as the absence of a thymus. The results demonstrate that human BCC can be successfully transplanted to the C57 beige-nude mouse without the need for supplemental immunosuppression. It may be that the impairment of NK cell activity in the beige-nude mouse model plays a significant role in tumor transplantation.

Lumbar arterial injury: radiologic diagnosis and management.

Injury of the lumbar arteries is a cause of potentially life-threatening retroperitoneal hemorrhage. Twelve patients who sustained massive hemorrhage of the lumbar arteries associated with lumbar spinal fractures and/or pelvic fractures are described. Computed tomography (CT) was helpful by revealing a distinct separation of the lumbar hemorrhage from the hematomas associated with pelvic fracture. On arteriograms, stasis within lumbar extravasation was manifested as globular or streaky accumulations of contrast medium, pseudoaneurysms or diffuse "staining," or opacification of a fracture site. Multiple lumbar bleeding sites were seen frequently. Embolization with pledgets of absorbable gelatin sterile sponge controlled bleeding in ten patients. Abdominal aortography should be an essential part of the arteriographic evaluation of retroperitoneal hematomas associated with pelvic fractures, especially when there are lumbar fractures. Selective lumbar arteriography should be performed for confirmation when there is suspicion of lumbar artery injury on the basis of aortographic findings. Embolization with pledgets of surgical gelatin is effective in controlling hemorrhage from these injuries.

The role of percutaneous angioplasty in the management of chronic hemodialysis fistulas.

One hundred forty-one dilatations of stenotic lesions in dialysis access fistulas were performed. The initial success rate was 82%. The one-year patency rate was 45%, with a 2-year patency rate of 24%. Best results were obtained with a discrete stenosis at a graft-to-vein anastomosis. The procedure can be done on an outpatient basis and, although long-term results are poor, in appropriate patients multiple dilatations can be performed to keep a fistula functioning for many years.

Percutaneous insertion of the Kimray-Greenfield filter: incidence of femoral vein thrombosis.

Venograms were obtained in 17 patients 5-8 days after percutaneous dilatation of the common femoral vein for insertion of the Kimray-Greenfield inferior vena cava filter. The venograms showed thrombosis of the common femoral vein in seven (41%) of the 17 patients, four of whom were symptomatic. Common femoral vein thrombosis can have serious clinical sequelae. The possibility of this complication should be considered before inserting the filter percutaneously via the femoral vein.

Percutaneous management of retroperitoneal abscesses.

Retroperitoneal abscesses have been a difficult diagnostic and therapeutic challenge in the past. With the advent of precise noninvasive imaging modalities, they now are defined more easily. Percutaneous guided catheter drainage has changed our therapeutic approach to this disease and enabled rapid and complete drainage to be performed in the majority of cases. Although the literature is replete with documentation of the percutaneous management of intra-abdominal abscesses, series dealing with retroperitoneal abscesses exclusively are surprisingly infrequent. We report on the percutaneous treatment of 31 retroperitoneal abscesses and the combined percutaneous and surgical management of 4 additional cases.

CT demonstration of giant choledochal cysts in adults.

The initial diagnosis for three adult patients with giant choledochal cysts was confused because of the enormous size of the cysts. Jaundice in association with marked upper gastrointestinal displacement was the dominant feature in two of our cases. Intrahepatic ductal dilatation is common when choledochal cysts present in the adult. The malignant potential of choledochal cysts is discussed.

Percutaneous coil embolization in the management of peripheral mycotic aneurysms.

Traditional surgical treatment of a peripheral mycotic aneurysm has included emergency ligation and bypass. Occlusion of vessels just proximal and distal to a mycotic aneurysm can be safely accomplished via percutaneous embolization with coils. Surgery can be performed electively in a non-infected field. Coils can be placed near the site of vessel disruption minimizing loss of collateral flow.