Distinct Margins Research Articles

Phenotypic profiling of keloid scars using FT-IR microspectroscopy reveals a unique spectral signature

Keloid disease (KD) is a quasineoplastic fibroproliferative tumour of unknown origin causing a progressive, recurrent dermal lesion. KD is not homogeneous in nature and shows phenotypic structural differences between its distinct peripheral margins compared to its centre. The keloid margin is often symptomatically more active with increased dermal cellularity, compared to a symptomatically dormant and hypocellular centre of lesion. The aim of this study was to delineate the morphological components of a keloid scar tissue by measuring the differences between various anatomical locations within the keloid tissue, such as the margin and the centre of the lesion compared to its surrounding normal skin using Fourier transform infrared (FT-IR) microspectroscopy. FT-IR microspectroscopy is a technique that produces spectra with detailed molecular biochemical information inherent of the chemical structure. Chemical maps were constructed on extralesional cross sections taken from six keloid scars. H&E stained sections were used to confirm diagnosis of keloid and orientate the experimental cross sections prior to FT-IR. Spectral band assignment and principal components analysis were conducted. Distinct vibrational bands (100 spectra) were observed using FT-IR spectroscopy. Partial least squares discriminant analysis, with bootstrapping (10,000 analyses), identified whether a spectrum was from the keloid or normal tissue showing an average accuracy of 84.8%, precision of 80.4%, specificity of 76.2%, and sensitivity of 92.9%. FT-IR microspectroscopy showed significant differences in spectral profiles in keloid tissue in different anatomical locations within the cross section. We believe that this proof-of-concept study may help substantiate the use of FTIR spectroscopy in keloid diagnosis and prognosis.

Late Early and early Middle Pleistocene limits of Scandinavian glaciations in Poland and Ukraine

The area of southern Poland and the Ukraine was occupied by ice sheets of the South Polish or Oka s.l. (Elsterian) Glaciation, comprising 3 separate glacial advances, that is, the Nidanian (Tursky), Sanian 1 (Vyzhivsk, Don) and Sanian 2 (Krukienice, Oka s.s.). An ice sheet of the Nidanian Glaciation reached its southernmost point in the interfluve of the upper Odra and the upper Vistula. An ice sheet of the Sanian 1 Glaciation advanced furthest to the south in south-eastern Poland and in south-western Ukraine. The Sanian 2 Glaciation (Oka s.s.) ice sheet was smaller in Poland but it was more widespread in the lower Pryp’iat and the middle Dnieper drainage basins. Distinctive lobate margins of the ice sheets were mostly due to adjustments to the relief of their forefields, and can be explained in terms of specific glacial dynamics in this part of Europe.

Rethinking Foreign Tax Creditability

International tax policy experts often mistakenly conflate two distinct margins: (1) the overall tax burden on outbound investment, and (2) the marginal reimbursement rate (MRR) for foreign taxes paid, which is 100 percent under a foreign tax credit system, but equals the marginal tax rate for foreign source income under an explicit or implicit deductibility system (such as exemption). From a unilateral national welfare standpoint, whatever the right answer at margin (1), deductibility is clearly optimal, and creditability dangerously over-generous, at margin (2).

Confirmation of European Brown Rot Caused by Monilinia laxa on Tart Cherry, Prunus cerasus, in Western New York.

Monilinia fructicola (G. Wint.) Honey and M. laxa (Aderh. & Ruhl.) Honey are two pathogens causing brown rot in the United States. While the presence of M. fructicola has been confirmed in all major stone-fruit-production regions in the United States, M. laxa has yet to be detected in much of the eastern production regions. In July 2008, a planting of tart cherries cv. Surefire in Appleton, NY developed severe shoot blight. Blighted shoots (>15% of first-year shoots) were wilted and light brown with the blight encompassing the distal end and often extending into second-year tissue with a distinct sunken margin. Leaves on symptomatic shoots had flushed, but were blighted. Blossom spurs were either blighted at bloom or bore fruit, which were subsequently blighted. Gummosis was commonly observed from cankers at the base of spurs. Both mature and immature mummified fruit in addition to spurs and shoot tissue were sporulating in a manner characteristic of Monilinia (2). Eleven branches displaying symptoms were removed for isolation. Sections of symptomatic shoots (5 cm long) were surface sterilized in 0.6% NaOCl for 1 min and rinsed in sterile dH2O. Cross sections of shoot tissue (3 mm thick), in addition to spores from fruit and spurs, were placed on potato dextrose agar amended with 50 μg/ml of streptomycin sulfate. Following incubation at 24°C for 5 days, 24 colonies exhibiting morphology consistent with that of M. fructicola (uniform colony margin) were obtained, along with nine colonies exhibiting lobed colony margins, commonly associated with M. laxa (3). All colonies resembling M. fructicola were isolated from fruit, whereas those resembling M. laxa were isolated from spurs and shoots. Conidia from both colony morphotypes were lemon-shaped, but those from putative M. laxa isolates were smaller on average (10.75 × 12.0 μm) compared with those from putative M. fructicola isolates (15.75 × 18.25 μm). Confirmation of M. laxa was also accomplished by inoculation of mature green pear (2). Pears inoculated with 104 putative M. laxa conidia per ml produced a region of white-buff colored mycelium but no spores within the inoculated area, while M. fructicola-inoculated pears sporulated abundantly. Identity was further confirmed by PCR amplification of the β-tubulin gene using M. laxa specific primers as previously described (1). Pathogenicity was proven by inoculating flowering shoots of tart cherry trees (cv. Montmorency) in spring 2009. Twenty shoots were spray inoculated with either 104 M. laxa conidia per ml or sterile dH2O and covered with plastic bags for 24 h. Shoots were monitored for symptom development on a weekly basis. Shoots inoculated with M. laxa developed characteristic shoot blight symptoms, while those inoculated with water remained healthy. M. laxa was reisolated from symptomatic shoots and spurs, but not water-inoculated tissues. The presence of M. laxa is reported for the Great Lakes region, which includes New York, but to our knowledge, this report is the first confirmed instance of economically devastating brown rot caused by M. laxa in New York. In the coming seasons, tart cherry growers must consider revising chemical management programs to protect against European brown rot infection during bloom.

First Report of Ascochyta Blight of Field Pea Caused by Ascochyta pisi in South Dakota

Tan lesions approximately 1.7 × 0.8 cm with distinct dark brown margins and small pycnidia were observed on leaves of field peas (Pisum sativum L. 'Agassiz') growing in Campbell County, South Dakota (45°45.62'N, 100°9.13'W) in July 2008. Small pieces of symptomatic leaves were surface sterilized (10% NaOCl for 1 min, 70% EtOH for 1 min, and sterile distilled H2O for 2 min) and placed on potato dextrose agar (PDA) for 7 days under fluorescent lights with a 12-h photoperiod to induce sporulation. A pure culture was established by streaking a conidial suspension on PDA and isolating a single germinated spore 3 days later. The culture was grown on clarified V8 media for 10 days. Conidia were 10 to 16 × 3 to 4.5 μm and uniseptate with a slightly constricted septum, similar to those of Ascochyta pisi Lib. The exuding spore mass from pycnidia growing on the medium was carrot red. No chlamydospores or pseudothecia were observed (1,2). To confirm the identity of A. pisi, DNA was extracted from the lyophilized mycelium of the 10-day-old culture with the DNeasy Plant Mini Kit (Qiagen, Valencia, CA). Internal transcribed spacer (ITS) regions I and II were amplified with PCR primers ITS 5 and ITS 4 (3). PCR amplicons were cleaned and directly sequenced in both directions using the primers. A BLASTN search against the NCBI nonredundant nucleotide database was performed using the consensus sequence generated by alignment of the forward and reverse sequences for this region. The consensus sequence (GenBank Accession No. GU722316) most closely matched A. pisi var. pisi strain (GenBank Accession No. EU167557). These observations confirm the identity of the fungus as A. pisi. A suspension of 1 × 106 conidia/ml of the isolate was spray inoculated to runoff on 10 replicate plants of 2-week-old, susceptible green field pea 'Sterling'. Plants were incubated in a dew chamber for 48 h at 18°C and moved to the greenhouse bench where they were maintained at 20 to 25°C with a 12-h photoperiod for 1 week. Tan lesions with dark margins appeared 7 days after inoculation and disease was assessed after 10 days (4). No symptoms were observed on water-treated control plants. A. pisi was reisolated from lesions and confirmed by DNA sequencing of the ITS region, fulfilling Koch's postulates. Currently, states bordering South Dakota (North Dakota and Montana) lead the United States in field pea production. Although acreage is limited in South Dakota, the identification of A. pisi in this region is serious. The disease is yield limiting and foliar fungicides are used for disease management (1). To our knowledge, this is the first report of Ascochyta blight on P. sativum caused by A. pisi occurring in South Dakota and the MonDak production region (the Dakotas and Montana).

Successful Removal of a Ruptured Orbital Cyst Using 2.3% Sodium Hyaluronate and Indocyanine Green.

A healthy 64-year-old man presented with a non-tender soft mass in the upper inner quadrant of the anterior left orbit. Magnetic resonance imaging revealed a 14 x 16 x 14-mm homogeneous cystic lesion in the anterior superonasal orbit with a distinct margin. An orbital cyst was suspected, and its surgical removal was planned. During the operation, the cystic mass ruptured unexpectedly and collapsed. Subsequently, a mixture of 0.5 mL of 2.3% sodium hyaluronate and 0.5 mL of 1% indocyanine green (ICG) was injected into the orbital cyst using a 27-gauge needle. Thereafter, the cyst became easily visible and clearly defined, which was successfully removed without difficulty. The usage of 2.3% sodium hyaluronate and ICG facilitated safe and complete excision of an accidentally ruptured orbital cyst.

On species composition of northern pacific genera Eurycope and Baeonectes and Redescription of E. ochotensis Kussakin, 1979 (Crustacea, Isopoda)

Two northwestern Pacific species of the munnopsid subfamily Eurycopinae, Eurycope pavlenkoi Gurjanova, 1933 and E. ochotensis Kussakin, 1979 are transferred to the other genus of the subfamily, Baeonectes Wilson, 1982, on the basis of the following characteristics: short truncated epipod of maxilliped, broad rostrum without distinct margins, absence of a distomedial lobe of the article 1 of antenna 1, mandible with broad, rounded molar and long condyle and pereonites 5–7 fused dorsomedially. Based on the mentioned characters E. pygmaea G.O. Sars, 1870, which was put into the genus Tytthocope Wilson & Hessler, 1981 is also suggested to be transferred into the genus Baeonectes. After the clarification of the taxonomical position of the species, the geographical range of the genus Baeonectes expanded. In the Sea of Japan the genus was registered for the first time.

Canine mesenchymal hamartoma of the eyelid

Characterization of a benign disease syndrome involving the eyelids of dogs, describing the signalment, clinical appearance, anatomic location, and pathologic features. The records and submitted tissue of 10 dogs with mesenchymal hamartomatous lesions of the periocular connective tissues were retrieved from the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW) database. The submitted tissue in each case was stained with hematoxilyn & eosin and Masson's Trichrome stain and examined histopathologically. Clinical information was collected from the submission requests. The clinical history, treatment, and follow-up are described in more detail for one of the 10 dogs. Seven different breeds, including four Golden Retrievers, were represented. The ages of affected dogs ranged from 6 to 11 years. Eight of 10 lesions were located at the temporal canthus, ranging in diameter from 0.6 to 3 cm. Clinically, the masses were subcutaneous, firm, lobular soft-tissue growths, which were in some cases adherent to the underlying orbital rim, and in others, freely palpable between the skin and conjunctiva of the eyelid. Histologically, all had distinct margins but were not encapsulated and contained normal appearing collagen-rich connective tissue with some adipose tissue. Five also contained fully differentiated skeletal muscle tissue arranged in poorly formed aggregates or as individual muscle fibers. Mesenchymal hamartoma of the eyelid has not been previously described. The mass has a predisposition to occur at the temporal canthus and should be included in the list of differential diagnoses of benign eyelid masses in dogs.

DIABETIC MASTOPATHY IN AN ELDERLY WOMAN: A CASE REPORT

We report a case of diabetic mastopathy in an elderly woman with type II diabetes. The patient, a 66-year-old woman with a 6-year history of diabetes mellitus, has been received an oral diabetic agent. She noticed a lump in her right breast two months previously. Mammography of the breast showed a low density mass, but there was no microcalcification or architectural distortion. Ultrasonography of the lesion revealed a hypoechoic mass with a distinct margin. Fine needle aspiration cytology was performed but sufficient tissue was not obtained. However, a cluster of small epithelial cells with nucleus swelling and increased chromatin was demonstrated. Excisional biopsy was performed and diabetic mastopathy was demonstrated histologically.

Repair of osteochondral defects with adipose stem cells and a dual growth factor‐releasing scaffold in rabbits

The purpose of this work was to evaluate the in vivo effectiveness of a TGF-beta(2) and bone morphogenetic protein (BMP)-7-immobilized porous polycaprolactone (PCL)/F127 scaffold to enhance the healing of cartilage defect. An osteochondral defect was created on the patellar groove of the right distal femur of 12 rabbits and managed by one of the following methods: filling it with the scaffold only (Group I); the scaffold seeded with adipose stem cells (ASCs) (Group II); a TGF-beta(2) and BMP-7-immobilized scaffold (Group III); and a TGF-beta(2) and BMP-7-immobilized scaffold seeded with ASCs (Group IV). Each group had three rabbits. Nine weeks after the implantation, the implanted scaffolds were filled with yellowish, dense tissue, and had distinct margins with adjacent normal cartilage. The histological findings showed infiltration of foreign-body giant cells and blood vessel, more prominently in Groups III and IV. The presence of growth factor significantly increased the ICRS Macroscopic Score (p = 0.045) while the presence of ASC did not. The ICRS Visual Histological Score was not significantly affected by the presence of either growth factors or ASCs, showing similar values in all groups. In conclusion, the use of TGF-beta(2) and BMP-7-immobilized PCL/F127 scaffolds improved gross appearances of the osteochondral defects while not actually leading to better histological results and induced a greater degree of foreign body reaction.

Dynamic Near-Infrared Optical Imaging of 2-Deoxyglucose Uptake by Intracranial Glioma of Athymic Mice

BackgroundIt is recognized that cancer cells exhibit highly elevated glucose metabolism compared to non-tumor cells. We have applied in vivo optical imaging to study dynamic uptake of a near-infrared dye-labeled glucose analogue, 2-deoxyglucose (2-DG) by orthotopic glioma in a mouse model.Methodology and Principal FindingsThe orthotopic glioma model was established by surgically implanting U87-luc glioma cells into the right caudal nuclear area of nude mice. Intracranial tumor growth was monitored longitudinally by bioluminescence imaging and MRI. When tumor size reached >4 mm diameter, dynamic fluorescence imaging was performed after an injection of the NIR labeled 2-DG, IRDye800CW 2-DG. Real-time whole body images acquired immediately after i.v. infusion clearly visualized the near-infrared dye circulating into various internal organs sequentially. Dynamic fluorescence imaging revealed significantly higher signal intensity in the tumor side of the brain than the contralateral normal brain 24 h after injection (tumor/normal ratio, TNR = 2.8±0.7). Even stronger contrast was achieved by removing the scalp (TNR = 3.7±1.1) and skull (TNR = 4.2±1.1) of the mice. In contrast, a control dye, IRDye800CW carboxylate, showed little difference (1.1±0.2). Ex vivo fluorescence imaging performed on ultrathin cryosections (20 µm) of tumor bearing whole brain revealed distinct tumor margins. Microscopic imaging identified cytoplasmic locations of the 2-DG dye in tumor cells.Conclusion and SignificanceOur results suggest that the near-infrared dye labeled 2-DG may serve as a useful fluorescence imaging probe to noninvasively assess intracranial tumor burden in preclinical animal models.

Wildfire of Soybean Caused by Pseudomonas syringae pv. tabaci, a New Disease in Korea.

In 2006 and 2007, a new bacterial disease was observed in field-cultivated soybeans in Boeun District and Munkyung City of Korea. The disease caused severe blighting of soybean (Glycine max) leaves. Soybean leaves in fields showed yellowish spots with brown centers. Brown and dead areas of variable size and shape were surrounded by wide, yellow haloes with distinct margins. Spots might coalesce and affected leaves fell readily. Seven bacterial strains were isolated from chlorotic areas of soybean leaves and all produced white colonies on trypticase soy agar. With the Biolog Microbial Identification System, version 4.2, (Biolog Inc., Hayward, CA) all strains and Pseudomonas syringae pv. tabaci CFBP2106T were identified as P. syringae pv. tabaci with a Biolog similarity index of 0.28 to 0.52 and 0.48 after 24 h. Pathogenicity of the strains (three plants per strain) on soybean leaves at the V5 stage (cv. Hwanggeum) was confirmed by rub inoculation with bacterial suspensions (1 × 108 CFU/ml) in sterile distilled water on the lesions cut 1 cm long on the upper side of the leaves with razor blades and by pinprick on 3-week-old leaves of tobacco (Nicotiana tabacum cv. Samsun) in the greenhouse. Wildfire symptoms on the soybean leaves and faint halos on tobacco leaves were observed 4 days after inoculation. The identification of reisolated bacterial strains was confirmed with the metabolic fingerprintings on Biolog. LOPAT tests (1) and phenotypic characteristics (3) of the strains were similar to those of the CFBP2106T. Colonies were levan positive, oxidase negative, potato soft rot negative, arginine dihydrase negative, and tobacco hypersensitivity negative. All strains were gram-negative, aerobic rods with a polar flagellum. Strains were negative for esculin hydrolysis, gelatin liquefaction, urea production, accumulation of poly-β-hydroxy butyrate, starch hydrolysis, ornithine dihydrolase, lysine dihydrolase, growth at 37°C, utilization of geraniol, benzoate, cellobiose, sorbitol, trehalose, l-rhamnose, and adonitol. Positive reactions were catalase and arbutin hydrolysis, utilization of sorbitol, d-arabinose, and dl-serine. The strains were variable in utilization of mannitol, sucrose, and d-arabinose. The 1,472-bp PCR fragments of strains, BC2366 (GenBank Accession No. FJ755788) and BC2367 (No. FJ755789) was sequenced using 16S rDNA universal primers (2). The sequences shared 100% identity with the analogous sequences of P. syringae pv. glycenea (GenBank Accession No. AB001443) available in NCBI databases. Based on the phenotypic, genetic, and pathological characteristics, all strains were identified as P. syringae pv. tabaci. To our knowledge, this is the first report of P. syringae pv. tabaci causing wildfire on soybean in Korea.

Acarospora ramosa (Acarosporaceae), a new effigurate yellow species from South America

Acarospora ramosa K. Knudsen & Flakus is described as new to science from the Bolivian Andes. It is characterized by a yellow, epruinose, rugulose thallus with a distinct effigurate margin, punctiform apothecia, and thin, branching and anastomosing paraphyses. The main diagnostic substances the new species produces are rhizocarpic and gyrophoric acids.

Unilateral Retinal Pigment Epithelium Dysgenesis

To report additional data on a pattern of the fundus described in 2002 as unilateral, idiopathic leopard-spot lesion of the retinal pigment epithelium (RPE). Observational, consecutive case series. The fundus characteristics, natural history, and prognosis of 9 patients are described after examining them by means of diagnostic adjuncts not previously available, including optical coherence tomography (OCT) and fundus autofluorescence (FAF) photographs. Nine patients, 6 male and 3 female, aged 14 to 42, presented with a large area, usually contiguous to the optic nerve, characterized by a distinct scalloped margin of reticular RPE hyperplasia, mid-lesion lacunae of RPE hyperplasia, and central thinning and atrophy of the RPE. FAF of the lesion showed a pattern that is inverted relative to fluorescein hyperfluorescence with a distinctive dark reticular pattern. OCT revealed fibroglial changes of the above retina in some cases. Two cases that have been documented up to 10 years showed enlargement of the affected area, one slightly and one significantly. Associated lesions included retinal folds (4 cases), retinal vascular tortuosity (4 cases), and progressive localized hyperplasia of the RPE (1 case). Related complications included choroidal neovascularization (2 cases) and localized retinal detachment (1 case). The inverted scalloped patterns of hyperfluorescence and hypofluorescence on fluorescein angiography and FAF with the newly described OCT features may help in the diagnosis of this rare condition of the RPE. Vision-threatening complications may be observed. Based on the present updated review of this condition, we suggest changing the name of this entity to "unilateral retinal pigment epithelium dysgenesis."

Stem rot of rice caused by Sclerotium hydrophilum isolated in Myanmar

Rice sheath and stem diseases caused by Rhizoctonia and Sclerotium species are problems in rice growing regions of Southeast Asia. In the summer season of 2007, in rice fields of Pyinmana Township in Myanmar, rice stems were visually observed with brownish to black lesions without distinct margins. The causal pathogen was isolated by placing 1 cm diseased stems on 2% water agar media and incubating at 28 ° C for seven days. The hyphae of the non-sporulating culture was stained with a mixture of safranine solution and 3% KOH (Bandoni, 1979). The hyphal width was measured to be within a range of 6 to 10 μ m and binucleate hyphae were observed between the septa. Small, globose and reddish brown to black coloured mature sclerotia measuring 0·24–0·43 mm were observed in culture. Based upon these characteristics, the fungus was initially identified as Sclerotium hydrophilum . On comparing the rDNA-ITS sequences of the isolate (GenBank Accession No. FJ595944) with that of a S. hydrophilum reference (DQ875597) there was found to be 99% identity. To confirm pathogenicity, ten rice sheath tissues were inoculated by placing a five day-old mycelial plug on the stem 1 cm below the axil of the fully mature leaf and wrapping with parafilm. Control plants were treated in the same manner using a plug of 2% water agar. After five days, symptoms on all inoculated plants were similar to those occurring in nature. Control plants did not develop symptoms. The fungus was re-isolated from inoculated plants, confirming Koch’s postulates. Stem rot of rice caused by S. hydrophilum has been reported previously in other rice growing countries in Southeast Asia (Kimiharu et al ., 2004), but this is the first report of this pathogen on rice from Myanmar. Further surveys and isolate collection will be needed to evaluate its geographic distribution and prevalence in Myanmar.

Evaluation of immunological profile and clinical characteristics in patients with vitiligo

Objective: Assess the presence of immune disorders in patients with vitiligo and the effects of low dose azathioprine and steroid as treatment. Methods: We enrolled 190 Taiwanese vitiligo patients at a rheumatology out-patient clinic, all of whom had previously failed to respond to topical corticosteroids and photochemotherapy. We recorded clinical features, disease course, and serological data commonly used in the diagnosis of autoimmune diseases. The response to low dose of azathioprine 25mg qd and prednisolone 5mg qd were assessed in each of four dimenions, including skin lesion progression, new skin lesions development, less distinct vitiligo margin and pigment regeneration by physician and patient visual analog scale. Results: 145 patients (76.32%) had simple vitiligo (no serological abnormality) and 45 patients (23.68%) had at least one serological abnormality. Of these 45 patients, 22 patients (11.58%) had systemic rheumatic disease (5 patients with systemic lupus erythematosus, 4 patients in each of psoriasis, spondyloarthropathy, and cryoglobulnemia, 2 patients with rheumatoid arthritis, and 1 patients in each of dermatomyositis, Behcet's disease, and hypersensitive angitis), 9 patients (4.74%) had thyroid disease, and 14 patients (7.37%) had serology abnormalities without diagnosis of specific disease. Most patients (174 patients, 91.58%) showed no more vitiligo progression and no development of new skin lesions within 2.3±1.1 months. Furthermore, 64 patients (33.68%) experienced a regression of skin lesions in 5.4±1.6 months, 52 patients (27.37%) experiencing a less distinct margin and 33 patients (17.37%) experiencing pigment regeneration. None of the patients reacted adversely to the treatment. Conclusion: Our study showed a possible immune dysregulation in patients with vitiligo as evidenced by presence of abnormal immune prfiles and association with other autoimmune diseases. Our data also disclosed that low dose systemic azathioprine and steroid were effective in treating this disorder.

The Features and Accuracy of Endosonography (EUS) On Diagnosis of Gastroduodenal Carcinoid Tumors

Background: Gastroduodenal carcinoid tumors are rare, indolent neuroendocrine tumors, identified incidentally during endoscopy for upper GI symptoms although some present as a bleeder. EUS is a sensitive method in the detection of gastroduodenal carcinoid, but the interobserver agreement was poor for carcinoid in diagnosis of subepithelial tumors (SET) even to experienced endosonographers. Aims: To evaluate the features and diagnostic accuracy of high-frequency ultrasound probe (HFUP) on gastroduodenal carcinoid tumors from other SETs. Methods: From Jan.2002 to Jul.2008, there were 65 patients with polyp or SETs, identified as suspected gastric or duodenal carcinoids by HFUP (Olympus UM-2R/3R) from EUS database of one institute (CGMH). After excluding tumors from muscularis propira, papillary location, and without histologic diagnosis, a total of 49 cases (stomach 28, duodenum 21) were analyzed retrospectively on EUS images/video, blind to final clinopathological outcomes. The Fisher's exact and The Mann-Whitney U-test was also used to compare the categorical and continuous variables. Results: There were total 20 patients (M: F=12: 8), mean age 57.5 yrs (39-84 yrs) with carcinoid tumors (gastric 10, duodenal 10), confirmed by endoscopic biopsy or resection. The size of carcinoid tumor is 7.6 mm +/-3.7 mm (mean +/- SD) on stomach, and 7.2 mm +/- 2.4 mm on duodenum. The three common EUS features included: distinct margin (75%), homogeneous hypoechoic lesion (80%) and deep mucosa to submucosal location (70%). Applying these EUS features (at least 2 criteria) for diagnosis of carcinoid tumors on all 49 cases, the positive predictive value is 62% and the negative predictive value is 83%, accuracy 71%. Comparing the tumor location showed: gastric body, 90% on carcinoid group, 33% on other gastric SETs (P=0.005); Duodenal bulb, 100% on carcinoid group, 27% on other duodenal SETs (P<0.001). Pathology of the misdiagnosed 29 SETs included: 9 ectopic pancreas, 8 inflammations, 3 GIST, 2 lipomas, 2 cysts, 1 MALT lymphoma, 1 Brunner's gland adenoma, 1 polyp. 2 undiagnosed lesion. Their mean sizes are 10.9mm +/- 6.1mm (stomach) and 9.2 mm +/- 3.4mm (duodenum). Conclusions: Most of gastroduodenal carcinoid tumors are less than 10 mm in size, with well-defined margin and hypoechoic nature in deep mucosal and submucosal layers. Tumor locations (eg. proximal stomach and duodenal bulb) are good predictive factors on differential diagnosis in addition to EUS features.

PET-CT Versus EUS Lymph Node Detection in Esophageal Cancer Patients: Implications for Dilatation Requirement

For the staging of esophageal cancer, endoscopic ultrasound (EUS) is the most sensitive modality to detect local and distant lymph nodes (LN). Dilatation of stenotic cancers to assess the celiac axis is often challenging and has a perforation risk up to 25%. Integrated positron emission tomography computed tomography (PET-CT) has reported incremental improvement for nodal staging over PET and CT alone. The aim of this study is to compare the detection of celiac LN by PET-CT and EUS. We specifically sought to determine whether a negative PET-CT could prevent the risks involved in dilatation at the time of EUS. Aim: To compare the detection of celiac lymph nodes by PET-CT and EUS. Methods: We retrospectively reviewed all staging EUS performed for esophageal carcinoma from January 2005 to December, 2008. Only patients treated with esophageal dilation with concomitant PET-CT reports were included in the analysis. Successful dilatations were defined by passage of the EUS scope into the stomach. Positive celiac LN detection by EUS was defined by the presence of any LN <2 cm away from the celiac axis with classic sonographic features of size >1.0 cm, round, and hypoechoic with distinct margins. Positive LN detection by PET-CT was defined by positive imaging by both modalities. Results: During the study period, 93 esophageal cancer patients underwent EUS; 34 also underwent dilation. 27 (79%) dilatations were successful. 10/27 patients were excluded (no PET-CT). Of the remaining 17 patients, 12 patients had both a negative EUS and PET-CT, 4 had a positive EUS and negative PET-CT, and 1 had a negative EUS and a positive PET-CT. In this cohort of patients with both EUS and PET-CT, and the negative predictive value for PET-CT was only 75%. Conclusion: PET-CT has a poor NPV and therefore a negative PET-CT does not eliminate the need for esophageal dilatation to assess celiac lymph nodes during EUS for esophageal cancer staging. Larger prospective studies comparing EUS and PET-CT are needed to determine the true accuracy of both staging modalities.

Taxonomy of the Carex backii Complex (Section Phyllostachyae, Cyperaceae)

Abstract A combination of macro- and micromorphological, anatomical, and phytogeographical data supports the recognition of three species in the Carex backii complex (within sect. Phyllostachyae). Carex backii is widely distributed throughout temperate and boreal regions of North America and is easily recognized by its long, smooth surfaced perigynia (4.8–6.6 mm) with long beaks (1.9–2.9 mm). The leaves are dull green to yellow-green with green, crenate margins. Carex saximontana is confined to the Great Plains region of North America and is distinguished by its shorter, papillose perigynia (3.2–4.9 mm) with much shorter beaks (0.6–1.2 mm). In addition, the leaves are greenish-glaucous to dark herbage-green with distinctive hyaline margins. Carex cordillerana occurs from central British Columbia to central Utah and is described as a widespread new species. Carex cordillerana can be recognized by its dull green to yellow-green leaves with green margins that are densely covered in papillae. Perigynia are in...

The Relationship between Intra-Operative Ultrasonography and Pathological Grade in Cerebral Glioma

The value of intra-operative ultrasound as a tool in guiding resection of cerebral gliomas and the relationship between the appearance of brain tissue on intra-operative ultrasonography and pathological grade of cerebral glioma were investigated in 98 patients who underwent neurosurgical tumour removal. Lesions were classified according to pathological grade. Intra-operative ultrasonography orientated all the cerebral gliomas accurately and helped the neurosurgeon in assessing the tumour prior to removal. All lesions were hyperechoic compared with normal brain tissue, and the majority of lesions displayed irregular shapes and indistinct margins. Different pathological grades of glioma presented different ultrasonographic appearances. The majority of low-grade (I and II) cerebral gliomas were homogeneous, with distinct margins and clear surrounding oedema compared with adjacent brain tissue. High-grade (III and IV) cerebral gliomas mostly exhibited poorly defined borders and central necrosis, and the surrounding oedema was difficult to distinguish from the lesions. Residual tumour or haematoma were identified. In conclusion, intra-operative ultrasonography is of great value in locating and assessing the grade of cerebral glioma, and is conducive to enabling early evaluation and total removal of the lesion.