ABSTRACT
Glial tumors of the retina are rare. Most are syndrome associated and include pilocytic astrocytoma in neurofibromatosis type 1 and subependymal giant cell astrocytoma in tuberous sclerosis complex. Acquired, more conventional, diffuse astrocytomas are less frequent. Ependymoma is exquisitely rare. Herein, we report the clinicopathologic features of the second case of retinal ependymoma. The tumor was sporadic in occurrence and unilateral, low grade, and of cellular type. Its chronic course and large size prompted an initial pathologic diagnosis of "massive retinal gliosis." The literature regarding retinal glial neoplasia including ependymoma as well as the so-called massive retinal gliosis is discussed.
Subject(s)
Ependymoma/ultrastructure , Retinal Neoplasms/ultrastructure , Adult , Ependymoma/complications , Ependymoma/surgery , Eye Evisceration , Female , Humans , Immunohistochemistry , Microscopy, Electron, Transmission , Retinal Detachment/complications , Retinal Neoplasms/complications , Retinal Neoplasms/surgeryABSTRACT
The use of herbal remedies is becoming increasingly popular in the United States. Research has shown that herbal remedy use may be associated with acute renal failure. In addition, the use of herbal remedies may be detrimental for the patient with compromised renal function. Patients with renal insufficiency or renal failure may be at risk for further kidney damage as well as complications related to interactions of herbal remedies with complex renal therapy regimens. This article will describe the escalating use of herbal therapy and the hazards of herbal remedy use among patients.
Subject(s)
Kidney Diseases , Phytotherapy , Drug Interactions , Drug and Narcotic Control , Evidence-Based Medicine , Humans , Kidney Diseases/chemically induced , Kidney Diseases/drug therapy , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Phytotherapy/adverse effects , Phytotherapy/statistics & numerical data , Risk Factors , Safety Management , United States , United States Food and Drug AdministrationABSTRACT
This article explores the limitations of the Patient Self-Determination Act. We need to think of advance directives as a process of understanding, reflecting, and discussing, not just a written document. Further, health care professionals must initiate the process of advance directive education in the outpatient setting. Our dialysis unit has successfully integrated this view into daily care of patients and families.
Subject(s)
Advance Directives , Patient Advocacy , Patient Education as Topic , Patient Participation , Advance Directives/legislation & jurisprudence , Aged , Dialysis/nursing , Female , Humans , Male , Middle Aged , Patient Advocacy/legislation & jurisprudence , United StatesABSTRACT
We reviewed 22 post-laser (Nd:YAG laser) coagulation bladder washes collected immediately after treatment. All washes demonstrated a striking artifact of cellular spindling. These spindled cells occurred singly, in loose clusters, and in lamellar stacks and had elongated nuclei with dense chromatin and bipolar cytoplasm that was fused in the stacks. Concurrent biopsies demonstrated similar cytologic changes. The spindling is a nonspecific epithelial response to heat. Conventionally electrocauterized epithelia show this artifact in biopsies, but since only the base of the lesion and surrounding urothelium are subjected to heat with electrocautery, the relatively few spindled epithelial cells created presumably go undetected in cytology specimens. With laser treatment, however, the whole urothelial surface of the lesion is coagulated, producing a much greater number of spindled cells. It is important to avoid misinterpreting the spindled cells as cells from a mesenchymal neoplasm or a sarcomatoid carcinoma, mistakes that were made in some of our initial cases. Malignancy cannot be evaluated when cells exhibit spindling artifact; this judgement should be made on undistorted cells. Thus, pre-laser and post-laser washes should be submitted for evaluation of malignancy.
Subject(s)
Artifacts , Laser Therapy , Urinary Bladder Neoplasms/pathology , Urinary Bladder/pathology , Cell Nucleus/pathology , Cytoplasm/pathology , Epithelium/pathology , Humans , Urinary Bladder Neoplasms/surgeryABSTRACT
Primary gastric lymphoma, (PGL), is thought to be a tumour of follicle centre cell origin containing centrocyte-like (CCL) cells, and plasma cell components. The advent of novel leucocyte antibodies reactive in paraffin sections and improved techniques for the demonstration of immunoglobulin (Ig) in tissues has permitted a reassessment of the histogenesis of PGL. Our results have shown that PGL is a tumour of CCL cells with plasma cell differentiation in a minority of cases. Follicles were reactive, as defined by polytypic expression of Ig, in each case but selective invasion of reactive follicles by neoplastic CCL cells often led to a misleading appearance of malignancy. CCL cells bear close similarities to marginal zone cells which have been defined as a distinct non-circulating B-cell lineage. This could account for the favourable clinical behaviour of PGL.