GATA3 Expression in Human Tumors: A Tissue Microarray Study on 16,557 Tumors.

INTRODUCTION: GATA3 is a transcription factor involved in epithelial cell differentiation. GATA3 immunostaining is used as a diagnostic marker for breast and urothelial cancer but can also occur in other neoplasms. METHODS: To evaluate GATA3 in normal and tumor tissues, a tissue microarray containing 16,557 samples from 131 different tumor types and subtypes and 608 samples of 76 different normal tissue types was analyzed by immunohistochemistry. RESULTS: GATA3 positivity was found in 69 different tumor types including 23 types (18%) with at least one strongly positive tumor. Highest positivity rates occurred in noninvasive papillary urothelial carcinoma (92-99%), lobular carcinoma (98%), carcinoma of no special type of the breast (92%), basal cell carcinoma of the skin (97%), invasive urothelial carcinoma (73%), T-cell lymphoma (23%), adenocarcinoma of the salivary gland (16%), squamous cell carcinoma of the skin (16%), and colorectal neuroendocrine carcinoma (12%). In breast cancer, low GATA3 staining was linked to high pT stage (p = 0.03), high BRE grade (p < 0.0001), HER2 overexpression (p = 0.0085), estrogen and progesterone receptor negativity (p < 0.0001 each), and reduced survival (p = 0.03). CONCLUSION: Our data demonstrate that GATA3 positivity can occur in various tumor entities. Low levels of GATA3 reflect cancer progression and poor patient prognosis in breast cancer.

Cervical Endocrine Surgery With a Novel Opioid-Limited Perioperative Protocol.

BACKGROUND: Recent studies have demonstrated that patients undergoing cervical endocrine surgery could be comfortably discharged with minimal opioid analgesia. However, no study to date has examined the efficacy of limiting administration of opioids intraoperatively. We have developed a novel protocol for patients undergoing cervical endocrine surgery that eliminates perioperative opioids. We sought to determine the efficacy of this protocol and its impact on opioid use at discharge. METHODS: We conducted a prospective opt-in opioid-limited surgery program study to opioid-naive patients scheduled for cervical endocrine surgery beginning in August 2019. Postoperatively, nonopioid analgesia was encouraged, but patients were also given a low dose prescription for opioids at discharge. Patients were then matched with 2 retrospective control groups, patients from 2014-2016 and 2017-2018, in order to account for increased public awareness of opioid-prescribing patterns. Primary end points included perioperative opioid use. Secondary end points included postoperative pain scores and complications. RESULTS: 218 patients underwent cervical endocrine surgery with our opioid-limited protocol between August 2019 and February 2020. Nine patients received opioids intraoperatively (4%) and 109 (50%) filled their opioid prescriptions at discharge. Compared to retrospective control groups, the average oral morphine equivalents (OME) administered intraoperatively and prescribed postoperatively were significantly lower (P < .0001). Pain scores and complication rates were similar in all groups (P = .7247). DISCUSSION: Our novel opioid-limited surgery protocol used in conjunction with preoperative counseling is an effective approach for pain control in patients undergoing cervical endocrine surgery and limits opioid exposure throughout the perioperative period.

Eye Disease in Medical Practice: What You Should Know and Why You Should Know It.

Incidence of cataract, diabetic retinopathy, macular degeneration, and glaucoma will significantly increase by 2050. Visual impairment can increase morbidity and mortality in nonocular disease. There are different patterns of vision loss in cataract, diabetic retinopathy, age-related macular degeneration, and glaucoma. Internists and medical subspecialists play an important role in prevention, detection, and early treatment of eye disease. Awareness of screening guidelines for eye disease as well as a basic ocular history and simple penlight examination can decrease incidence of vision loss and its impact. Visual impairment places a significant financial burden on society.

Bilateral tension pneumothorax following equipment improvisation.

This case report describes an unexpected event that took place as a result of using improvised equipment. The patient, a 16-year-old female undergoing complex oral surgery, suffered bilateral pneumothorax following the improper use of an airway support device. During the immediate postoperative period with the patient still intubated, oxygen tubing was attached to a right angle elbow connector with the port closed and 10 L/minute oxygen flow was administered to the patient in a manner that did not allow the patient to exhale. Within seconds, pneumothorax was apparent as the patient's vital signs deteriorated, visible swelling was noted in the shoulders and neck, and there was an absence of breath sounds on auscultation. This case study has application beyond the immediate discussion of bilateral pneumothorax, serving as a caution about the unintended consequences of equipment improvisation. In addition to highlighting the hazards of providing patient care with a non-standard device, this study also provides a powerful example of the human factors that can contribute to medical errors in the healthcare setting.

A countywide outbreak of pertussis: initial transmission in a high school weight room with subsequent substantial impact on adolescents and adults.

OBJECTIVE: To describe a large communitywide pertussis outbreak where aggressive diagnostic and treatment measures were used to control the outbreak. DESIGN: Retrospective analysis, May 2003 through February 2004. SETTING: Fond du Lac County, Wisconsin (population 98,882). PARTICIPANTS: Health department personnel conducted case and contact investigations of suspected outbreak-associated illnesses using standard pertussis reporting forms and clinical evaluation and management protocols. Persons with compatible illness were tested for Bordetella pertussis using culture and for B pertussis DNA using polymerase chain reaction. Cases were classified using Council of State and Territorial Epidemiologists definitions. INTERVENTIONS: Health alerts and aggressive testing and treatment of suspected cases of pertussis illness and contact prophylaxis in the community. MAIN OUTCOME MEASURES: Incidences by age, onsets over time, and vaccine coverage in case patients. RESULTS: We identified 261 pertussis cases among county residents; 149 (57%) were laboratory confirmed. Of the first 57 case patients, 47% reported using a particular high school weight room. Pertussis incidence was high in all age groups; 86% of case patients were 10 years or older. Among 156 case patients with reported vaccination histories, 84% had received 5 or more doses of pertussis-containing vaccine. Adults reported significantly more severe pertussis symptoms than adolescents. CONCLUSIONS: Pertussis transmission among adolescents using a school weight room instigated a countywide outbreak with substantial incidence and morbidity among adolescents and adults. Aggressive testing and treatment in the outbreak response likely contributed to a sharp reduction in cases. This labor- and resource-intensive outbreak highlights potential benefits of pertussis booster vaccination among adolescent and adult populations.

Evaluation of polymerase chain reaction and culture for diagnosis of pertussis in the control of a county-wide outbreak focused among adolescents and adults.

During a large pertussis outbreak, culture and polymerase chain reaction (PCR) were used to identify 149 case patients; of these case patients, 79 had positive PCR and culture results, 59 had positive PCR results and negative culture results, 11 had negative PCR results and positive culture results (10 PCR-negative, culture-positive specimens were collected < or = 14 days after illness onset). PCR and culture of samples obtained < or = 2 weeks after illness onset and PCR of samples obtained > 2 weeks after illness onset proved to be most diagnostically useful.