ABSTRACT
BACKGROUND: We assess the performance of ultrasound (US) and hepatobiliary scintigraphy (HIDA) as confirmatory studies in acute cholecystitis (AC) and demonstrate our current imaging protocol's impact on outcomes. STUDY DESIGN: Between January 2013 to July 2014, 117 patients were admitted through the emergency room with a preliminary diagnosis of AC. Overall, 106/117 (91%) of the patients received US preadmission and 34/117 (29%) received a HIDA post admission. Primary end points included: 1) diagnostic test reliability for AC, and 2) outcome and quality measures (time to surgery, LOS, costs, etc.). RESULTS: Laparoscopic cholecystectomy was performed in 96/117 (82%) and open cholecystectomy in 21/117 (18%) of the patients. Overall, histopathologic features consistent with AC was present in 46/117 (39%). AC alone was present in 23/117 (20%), and AC superimposed on chronic cholecystitis was present in 23/117 (20%). For AC, US had a sensitivity and specificity of 26% and 80%, respectively. HIDA scan had a sensitivity and specificity of 87% and 79%, respectively. Time to surgery (TTS) was 4 vs 2.3 days in patients who received HIDA vs US alone (p = 0.001), and length of stay (LOS) was 6.7 vs 4.3 days, respectively (p = 0.001). Age >50 years, glucose >140 (mg/dl), and WBC count >10 (×109 /L) were statistically significant independent variables associated with AC. CONCLUSION: HIDA scan is superior to US as a diagnostic study in the setting of AC. Our current protocol of delayed HIDA (post-admission) was associated with increased TTS, LOS, and overall costs. Early confirmation with HIDA in high risk patients may hasten treatment allocation and improve outcomes in the setting of AC.
Subject(s)
Cholecystitis, Acute/diagnostic imaging , Adult , Cholecystectomy , Cholecystectomy, Laparoscopic , Cholecystitis, Acute/economics , Cholecystitis, Acute/pathology , Cholecystitis, Acute/surgery , Costs and Cost Analysis , Female , Humans , Imino Acids , Male , Middle Aged , Radionuclide Imaging , Radiopharmaceuticals , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , UltrasonographyABSTRACT
Nanog is a transcription factor that is well-established as a key regulator of embryonic stem cell (ESC) maintenance. Recent evidence demonstrates that Nanog is dysregulated and intimately involved in promoting tumorigenesis in part through regulation of the cancer stem cell (CSC) population. Elevated Nanog is associated with poorer outcome in numerous epithelial malignancies. Nanog is enriched in CSCs and ablation of Nanog is sufficient to reduce the CSC pool. Nanog has also been implicated to promote chemoresistance and epithelial-mesenchymal transition (EMT). Insight into the Nanog signaling cascade, upstream regulators and downstream effectors, is beginning to emerge but remains to be fully elucidated. This review highlights the current literature on the emerging role of Nanog in tumorigenesis and CSCs.
Subject(s)
Gene Expression Regulation, Neoplastic , Homeodomain Proteins/physiology , Neoplastic Stem Cells/cytology , Animals , Biomarkers, Tumor/physiology , Breast Neoplasms/metabolism , Carcinogenesis , Carcinoma, Hepatocellular/metabolism , Colorectal Neoplasms/metabolism , Epithelial-Mesenchymal Transition , Female , Head and Neck Neoplasms/metabolism , Humans , Liver Neoplasms/metabolism , Lung Neoplasms/metabolism , Male , Mice , NIH 3T3 Cells , Nanog Homeobox Protein , Ovarian Neoplasms/metabolism , Phosphorylation , Prognosis , Prostatic Neoplasms/metabolism , Signal Transduction , Stomach Neoplasms/metabolism , Treatment OutcomeABSTRACT
Among salivary gland neoplasms, metastasizing pleomorphic adenoma (MPA) constitutes an extremely rare group of tumors. The present paper reports a case of pleomorphic adenoma (PA) in submandibular gland that, after more than 30 years of initial treatment, recurred and metastasized to ipsilateral neck lymph nodes and parotid gland. In an attempt to elucidate the malignant behavior of metastasizing pleomorphic adenoma, we performed Ki-67, p53, p16, and bcl-2 immunohistochemistry staining of our case sample. Many immunohistochemistry staining studies have been done on malignant salivary gland tumors. However, to the best of our knowledge no immunohistochemistry staining of the aforementioned markers has been previously performed on metastasizing pleomorphic adenoma.
