Fatal Diagnosis Research Articles

The Myth of Choice

The Myth of Choice

The impact of diagnosis on the psychosocial and spiritual needs of the patients

Introduction: Holistic care focuses on the relationship between the body, mind, and spirit. Spiritual needs are among the basic needs of the individual. From the physical and spiritual dimension and the interaction of these two dimensions, the spiritual needs of the person are developed. Aim:The aim of our study was to analyze if the patient's knowledge regarding their diagnosis and possible proximity of death have significant impact on satisfaction of psychological and spiritual needs. Material and Methods:In our study we used standardized questionnaire The Spiritual Needs Assessment for Patient – SNAP constructed by Sharma Rashmi, applied for 113 respondents and processed by SPSS statistical program. Results:Reliability of questionnaire is given by Cronbach's Alpha 0.945 for the total SNAP. A statistically significant difference at the level p < 0.01 has been confirmed in all questions among respondents with fatal diagnosis and respondents with not life-threatening diagnosis. In domain of psychosocial needs, significant difference was not confirmed regarding to gender, age, education, income, religion and place of residency. In domain of spiritual needs, significant difference was partially confirmed regarding religion in 4 questions from 13. Conclusion:Faced with chronic or fatal diseases, many patients rely on dealing with spiritual and religious issues. In fact, spirituality/religiosity can be considered an important source of support and management of severe chronic diseases. It is possible to identify the four basic dimensions of spiritual need: interconnection, peace, meaning/purpose, and transcendence. Patients often have the problem addressing their needs for related psychosocial and physical problems such as physical disability, fatigue, sleep disorders, side effects of treatment, etc. Importance of satisfaction of psychosocial and spiritual needs is increased in time of threat, fatal diagnosis.

Palliative care in maternity units

Over recent years, palliative care in maternity units has developed considerably. This is due to the evolution of legislation, medicine and requests from many parents, faced with a fatal prenatal diagnosis, to continue with the pregnancy and support their baby at birth. In parallel, the neonatal intensive care of extremely premature babies has improved significantly. Different situations can be concerned by the setting up of palliative care in maternity units. This specific support comprises significant challenges.

Fatal diagnosis of hemophagocytic lymphohistiocytosis in a patient with a history of human immunodeficiency virus, Hodgkin’s lymphoma, and Epstein–Barr virus

Fatal diagnosis of hemophagocytic lymphohistiocytosis in a patient with a history of human immunodeficiency virus, Hodgkin’s lymphoma, and Epstein–Barr virus

421. Babesiosis: Retrospective Review of 38 Cases from Upper Midwest

BackgroundBabesiosis is a tick-borne illness caused by protozoal infection of the genus Babesia. Clinical presentation varies widely from asymptomatic to rapidly fatal infection and diagnosis requires a high index of clinical suspicion. It is an emerging health risk and clinicians need to be aware of its different clinical manifestations.MethodsWe retrospectively collected and analyzed data from 38 patients with babesiosis from 1990 to 2015.ResultsMean age of patients was 63 years. 68% of patients required hospitalization with 21% requiring intensive care unit (ICU) stay. Mean length of illness before diagnosis was 15.6 days and symptoms comprised of malaise (82%), subjective fever (71%), chills (55%), anorexia (29%), arthralgia (29%), and nausea (16%). Only 47% of the patients recalled tick bites. Mean hemoglobin in the outpatients was 12.4 g/dL compared with 9.8 g/dL in the hospitalized patients (P < 0.01). Among hospitalized patients, mean hemoglobin for ICU admissions was 7.5 g/dL vs. 10.9 g/dL (P < 0.01) for those without ICU stay. Mean parasitemia was 10.1% in those requiring ICU compared with 1.4% in those admitted to the medical floor (P < 0.01). 28.9% had Lyme disease, and 10.5% had anaplasma coinfection. Co-morbidities included diabetes mellitus (n = 3), asplenia (n = 5), and immunosuppression (n = 3). Diagnosis was made with PCR and peripheral smear in 50% of patient whereas 50% were diagnosed with PCR alone. In 27% of patients with positive PCR, peripheral smear was negative. All patients with asplenia required hospitalization with 3/5 requiring ICU with initial parasitemia ranging from 2.5 to 28% and duration of parasitemia ranging from 10 to 142 days. Initial treatment comprised of clindamycin plus quinine in 31% of patients whereas combination of atovaquone and azithromycin was used in 69% of patients. Median duration of treatment was 10 days. Overall three patients underwent exchange transfusion with parasitemias ranging from 12.3 to 28.5%. None of the patients died during hospitalization.ConclusionLess than half of the patients with babesiosis recall tick bites. There is usually a delay in diagnosis of up to 2 weeks due to nonspecific nature of symptoms. In more than one-fourth of patients with babesiosis peripheral smear may be falsely negative. Hemoglobin and percentage parasitemia seemed to correlate with severity of illness.Disclosures All authors: No reported disclosures.

PS01.101: SURGICAL MANAGEMENT OF ADULT ESOPHAGO-RESPIRATORY FISTULA: A TEN-YEAR EXPERIENCE.

Abstract Background Adult esophago-respiratory fistula is a rare condition, which is usually seen in malignancies or in benign conditions following trauma, infection or as a delayed presentation of congenitall tracheoesophageal fistula. They pose a technical challenge in stabilisation and management requiring multidisciplinary approach. Methods In this retrospective analysis of such cases over a period of ten years, who presented to our centre. The aetiology, presentation and treatment modalities were studied in detail. Of these,18 patients with benign esophago repiratory fistulae underwent surgical correction oft he same. This is discussed in detail. Results There were a total of 62 cases of adult esophago-respiratory fistula, over the 10 year period. Of the patients, 34 of the cases to be of malignant etiology and 28 of the cases to be of benign etiology such as prolonged tracheostomy, corrosive injury, infection, trauma or delayed presentation of congenital fistula. The mean age of presentation was 44 years. (range 18 to 81 years of age). There were 35 tracheoesophageal fistulae and 27 bronchoesophageal fistulae. Fourteen patients underwent esophageal stenting and 9 underwent tracheal stenting either as a temporary intervention to alleviate symptoms or as palliative intervention. Eighteen patients underwent definitive surgical intervention. Surgical repair involved approach through neck in 6 patients and thorax in 11 patients and a combination of both approaches in one patient. The esophageal end of the fistula was primarily closed or closed with the help of a pleural or pedicled muscle flap or a subtotal esophagectomy was performed. The respiratory end of the fistula was either primarily closed or with the help of a vascularized patch of the esophageal wall. The latter technique was used in four patients and is explained in detail. Conclusion Due to risk of fatal complications, early diagnosis, multidisciplinary approach and appropriate surgical intervention after nutritional build up is the key to successful management of adult esophago-respiratory fistula. Disclosure All authors have declared no conflicts of interest.

Combined Modulation of Tumor Metabolism by Metformin and Diclofenac in Glioma.

Glioblastoma remains a fatal diagnosis. Previous research has shown that metformin, which is an inhibitor of complex I of the respiratory chain, may inhibit some brain tumor initiating cells (BTICs), albeit at dosages that are too high for clinical use. Here, we explored whether a combined treatment of metformin and diclofenac, which is a non-steroidal anti-inflammatory drug (NSAID) shown to inhibit glycolysis by interfering with lactate efflux, may lead to additive or even synergistic effects on BTICs (BTIC-8, -11, -13 and -18) and tumor cell lines (TCs, U87, and HTZ349). Therefore, we investigated the functional effects, including proliferation and migration, metabolic effects including oxygen consumption and extracellular lactate levels, and effects on the protein level, including signaling pathways. Functional investigation revealed synergistic anti-migratory and anti-proliferative effects of the combined treatment with metformin and diclofenac on BTICs and TCs. Signaling pathways did not sufficiently explain synergistic effects. However, we observed that metformin inhibited cellular oxygen consumption and increased extracellular lactate levels, indicating glycolytic rescue mechanisms. Combined treatment inhibited metformin-induced lactate increase. The combination of metformin and diclofenac may represent a promising new strategy in the treatment of glioblastoma. Combined treatment may reduce the effective doses of the single agents and prevent metabolic rescue mechanisms. Further studies are needed in order to determine possible side effects in humans.

Loneliness, social isolation and risk of cardiovascular disease in the English Longitudinal Study of Ageing.

Background There is increasing evidence of an association between social relationships and morbidity in general, and cardiovascular disease in particular. However, recent syntheses of the evidence raise two important questions: is it the perceived quality or the more objective quantity of relationships that matters most; and what are the implications of changes in relationships over time? In this study, we investigate the cumulative effects of loneliness and social isolation on incident cardiovascular disease. Design A secondary analysis of prospective follow-up data from the English Longitudinal Study of Ageing (ELSA). Methods To assess the association between social isolation or loneliness and incident cardiovascular disease, lagged values of exposure to loneliness and isolation were treated as time-varying variables in discrete time survival models controlling for potential confounders and established cardiovascular disease risk factors. Results A total of 5397 men and women aged over 50 years were followed up for new fatal and non-fatal diagnoses of heart disease and stroke between 2004 and 2010. Over a mean follow-up period of 5.4 years, 571 new cardiovascular events were recorded. We found that loneliness was associated with an increased risk of cardiovascular disease (odds ratio 1.27, 95% confidence interval 1.01-1.57). Social isolation, meanwhile, was not associated with disease incidence. There was no evidence of a cumulative effect over time of social relationships on cardiovascular disease risk. Conclusions Loneliness is associated with an increased risk of developing coronary heart disease and stroke, independently of traditional cardiovascular disease risk factors. Our findings suggest that primary prevention strategies targeting loneliness could help to prevent cardiovascular disease.

Development of a Brief Psychoanalytic Group therapy (BPG) and its application in an asbestos national priority contaminated site.

The aim of the present paper is to describe the development of a Brief Psychoanalytic Group therapy for contaminated sites and its application in the National Priority Contaminated Site of Casale Monferrato. Before presenting the core of the clinical intervention, a brief examination of some clinical features encountered working with malignant mesothelioma patients and their caregivers is offered. These aspects have been pivotal elements in the construction of a psychoanalytically oriented time-limited (i.e., 12 sessions) group therapy. This model of intervention was designed by one of the Authors (AG) and is aimed at reducing the impact of living in a threatening place where both physical well-being and health are put to the test. At a psychological level, in fact, living in contaminated sites arouses death anxieties, which can deeply compromise the quality of time remaining to live together with loved ones after a fatal cancer diagnosis.

Aluminum Phosphide Poisoning: A Rare Presentation

Aluminum phosphide (ALP) is extremely lethal and invariably suicidal in nature.1 It is a major cause of suicidal poisoning in many countries.2, 3 Toxicity by ALP is caused by the liberation of phosphine gas, which causes cell hypoxia due to inhibition of oxidative phosphorylation leading to circulatory failure.3 Treatment of ALP toxicity is mainly supportive as there is no specific antidote. Mortality with ALP poisoning is very high, ranging from 37% to 100%.4, 5 A 40-year-old female was admitted to R.L Jalappa hospital kolar with complaints of nausea, vomiting and epigastric pain h/o after ingestion of 7 to 8 tablets of unknown composition and 20 tablets of cetrizine. She had a history of bronchial asthma. On arrival, she was alert and hemodynamic status with pulse rate of 130 beats/min and blood pressure 110/70 mm/hg. There was not any abdominal tenderness or guarding, no cyanosis, jaundice or edema of feet. Gastric lavage initiated, but after 2 hour her condition deteriorated with cardio toxicity, resistant hypotension, tachycardia, epigastric pain, generalized tonic-clonic seizure (GTCS), Arterial blood gas (ABG) showed severe metabolic acidosis. Electrocardiogram (ECG) showed extensive inferolateral ST elevation myocardial infarction (STEMI). After few hours of admission, rhythm became ventricular fibrillation (VF) and cardiopulmonary resuscitation (CPR) began but it was unsuccessful. As aluminum phosphide poisoning leads to fatal condition, early diagnosis and proper management is warranted, this can be reduce the morbidity and mortality. But sometimes early diagnosis may not save the victim as in our case. We present a case wherein the victim succumbed to death due to acute respiratory failure and bleeding diathesis following consumption of aluminum phosphide.

TB Iris: A clinical outcome among HIV patients receiving antiretroviral therapy in a tuberculosis prevelant area

Introduction:IRIS remains as a major obstacle in effective administration of antiretroviral therapy. This study primarily focuses on evaluating the frequency of occurrence of TB-IRIS among HIV patients on antiretroviral therapy. Secondly, it focuses on establishing risk factors or predictors in patients developing TB-IRIS and finally this study aims to determine the various clinical outcomes and effect of IRIS development on survival rates among these patient. Materials & Method:This study is retrospective hospital based executed in the ART centre in Mangalore, Karnataka. Diagnosis of TB-IRIS was made as per INSHI consensus case definition provided for resource-limited settings. The Data from January 2008 till September 2012 was evaluated via semi-structured questionnaire. Inclusion Criteria Patients eligible to receive ART and were above the age of 18. Those patients who were non-compliant with treatment or HIV patients no ton ART were excluded from our sample population Results:A total of 125 patients were included in this study. 37(29.6%) had diagnosed TB before starting the treatment. 6(16.2%) out of the 37 HIV with combined TB patients progressed to paradoxical TB-IRIS when ART drugs were initiated. 88(70.4%) patients did not have active TB when ART was started, among whom 6 patients developed “unmasking” TB-IRIS. 8 (66.7%) out of the 12 patients developed IRIS in a period of three months of initiation of ART rest 4 (33.3%) patients developed after the three month period. 10 (83.33%)out of the 12 patients were male. 5 out of the 6 patients with paradoxical TB-IRIS had extra-pulmonary TB at the time of ART initiation. Conclusion: Consensus case definition for the resource limited setting is an effective tool in the diagnosis of TB-IRIS. TB-IRIS can be treated conservatively and although not fatal early diagnosis and management can prevent a complicated course of disease.

Posterior Inferior Cerebellar Infarct in a Younger Adult Male with Vertigo and Ataxia

Vertigo is a common complaint in patients who present to the emergency department. It can be a manifestation originating from several different disease processes. Although most patients with vertigo, especially younger patients, will have a benign disorder, up to 3% of such patients will have a cerebellar infarct. Although ruling out these types of fatal diagnoses is essential for emergency medicine physicians, this task can be especially complicated. Classic signs of a cerebellar infarct include symptoms suggestive of central vertigo with focal neurologic deficits on physical exam. Up to 10% of patients with cerebellar infarctions, however, present to the emergency department with vertigo and no focal neurologic deficits. The following case report discusses a male in his late twenties with the chief complaint of vertigo. On initial exam, he had no focal neurologic deficits but did have other concerning symptoms including severe ataxia. Imaging subsequently revealed the patient to have sustained a cerebellar infarct. When differentiating benign forms of vertigo from cerebellar infarcts or other central causes, the clinician should take into account risk factors such as central symptoms including neurologic deficits and severe ataxia. Implementing this strategy may decrease morbidity and mortality associated with cerebellar infarctions.

La enfermera ante el paciente terminal de la UCI

El objetivo de este trabajo es realizar una revisión bibliográfica de las publicaciones existentes acerca del duelo en pacientes fallecidos en el hospital. Material: se ha realizado una búsqueda sistemática en las bases de datos Pubmed, Cuiden, Cochrane. Resultados: Actualmente más del 80% de los fallecimientos sucede en hospitales, por lo que los familiares ya padecen las fases del duelo en el centro sanitario. La doctora Kübler-Ross tras un estudio con más de doscientos pacientes moribundos estableció las fases del duelo por las que pasaba un paciente tras conocer un diagnóstico mortal: negación, ira, negociación, depresión y aceptación. Existen claras referencias que ponen de manifiesto los efectos positivos de la integración e implicación familiar en el cuidado del paciente crítico. Discusión: la muerte forma parte de nuestro trabajo en hospitales sin que nos resulte indiferente. Muchos de los dilemas éticos con que nos encontramos los enfermeros se generan por diversos factores, y por lo general, no nos gusta afrontar esas situaciones y acabamos poniendo distancia de por medio, tanto física como emocional. Los estudios demuestran que con una enfermera centrada en mejorar la comunicación con las familias de un paciente ingresado se puede reducir el tiempo de estancia hospitalaria y gestionar mejor la utilización de recursos materiales.

Periodic EEG patterns in sporadic Creutzfeld-Jakob-Disease can be benzodiazepine-responsive and be difficult to distinguish from non-convulsive status epilepticus

PurposePeriodic discharges in EEG and a history of rapidly progressive dementia are known to be associated with sporadic Creutzfeld-Jakob Disease (sCJD). Doubts regarding this rare but fatal diagnosis can arise, when episodic symptoms (seizures, psychiatric features, speech disturbances) are present and the EEG shows epileptiform discharges within this periodicity. This scenario may indicate non-convulsive status epilepticus (NCSE), which is – in contrast to sCJD – a treatable and frequent condition. MethodsHerein we report a small retrospective study of 4 elderly patients, who suffered from sCJD, but due to episodic symptoms and benzodiazepine-responsive epileptiform discharges in combination to a subacute cognitive decline, NCSE was considered as a potential differential diagnosis and therefore treated aggressively. ResultsUltimately, this treatment was not successful and sCJD was diagnosed in all cases. Hence, there was no diagnostic and prognostic value of abolishing periodic discharges in EEG via benzodiazepines in differentiating sCJD from NCSE in our series. ConclusionThese findings indicate that periodic discharges in sCJD can be responsive to benzodiazepines andnot necessarily help to differentiate differentiation between sCJD and NCSE of other causes. We argue that an aggressive anticonvulsive treatment in this scenario should be considered cautiously, especially for invasive options like general anesthesia.

MA 19.06 Multiple Mechanisms Contribute to Downregulation of Tumor Suppressor microRNAs in Malignant Pleural Mesothelioma

Malignant pleural mesothelioma (MPM) is a disease with an almost invariably fatal diagnosis with limited therapeutic options. Characteristic patterns of deregulated microRNA expression have been demonstrated in MPM, and many downregulated microRNAs have been shown to have tumor suppressor activity. However, apart from silencing of miR-34b/c by promoter hypermethylation and co-deletion of miR-31 with the CDKN2A locus, the mechanisms responsible for downregulation of other tumor suppressor miRNAs such as miR-16 are yet to be elucidated.

Gastric Mucormycosis as a Cause of Upper Gastrointestinal Bleeding in an Immunocompetent Patient

Introduction: Mucormycosis is an opportunistic fungal infection primarily diagnosed in immunocompromised individuals. While most cases are either rhinocerebral or pulmonary; gastrointestinal manifestation of the disease is very rare. We report the first case of gastrointestinal mucormycosis (GM) in a male patient with a recent history of intravenous heroin use and binge drinking. Case: A 36-year old Male patient that was brought to our hospital after being found unresponsive and cyanotic. On examination the patient was afebrile but tachycardic (pulse 112beats/min), tachypnic (RR =32/min), and hypotensive (BP 89/56 mmHg). His pupils were pinpoint but reactive and his cutaneous examination revealed numerous track marks along the upper extremities. Patient was stabilized, intubated and admitted to the medical intensive care unit. On hospital day 3, the patient had 3 episodes of melena associated with a 4gm decrease in hemoglobin. Gastric lavage was notable for coffee ground material mixed with clotted blood. An esophagogastroduodenoscopy (EGD) revealed a 5cms necrotic appearing ulcer along the greater curvature of the stomach with surrounding exudate (Figure 1A). The histopathology showed necrotic mucosa with acute on chronic inflammatory infiltrate and many microorganisms. Special periodic-acid schiff and methanine-silver stains showed broad, irregular, nonseptate hyphae with right-angled branching consistent with primary GM (Figure 1B, 1C). Patient was seen by Infectious Disease and prescribed oral Posaconazole. Due to financial restrictions he never started the medication. Repeat EGD at 12 weeks revealed complete resolution of the ulcer (Figure 2).Figure: Necrotic Ulcer with Surrounding Exudate.Figure. 1B: Periodic-Acid Schiff Stains 1C-Methanine-Silver Stains Broad, Irregular, Nonseptate Hyphae with Right-Angled Branching.Figure: Normal Esophagogastroduodenoscopy.Discussion: Gastrointestinal mucormycosis is an exceedingly rare but fatal diagnosis. The pathologic hallmark of mucormycosis is infarction of host tissue resulting from angioinvasion of the hyphae. We hypothesize that contaminated needles and subsequent colonization of presumed gastric erosions due to heavy episodic alcohol use facilitated hyphal invasion and lead to infarction and necrosis of the gastric mucosa. Despite the need for aggressive antifungal treatment with or without surgical debridement our patient fully recovered without therapy. Interestingly, discontinuing alcohol and drug use must have lead to the reconstitution of his immune system causing self-healing of the gastric ulcer in an otherwise immunocompetent patient.

Anisocoria secondary to inadvertent contact with scopolamine patch

A unilaterally fixed mydriasis, also known as a ‘blown pupil,’ is considered an ominous sign concerning for intracranial pathology. Causes of anisocoria can range from benign to immediately life-threatening. When...

Germ cell tumor causing pleural effusion: A diagnostic dilemma

Straw colored pleural fluid with raised adenosine deaminase (ADA) levels in young healthy adults usually raises suspicion of tuberculosis, sometimes leading to laxity in carrying thorough physical examination and missing out some important clues with potential disastrous consequences. A 35-year-old male was diagnosed to have left pleural effusion and anti-tubercular treatment was started on the basis of straw colored, lymphocyte-predominant pleural fluid with significantly raised ADA levels. When there was no improvement after 1 month of treatment he was investigated further and found to have a mediastinal mass along with hydro-pneumothorax. Fine needle aspiration cytology (FNAC) of the mass was done twice at different centers with different reports followed by biopsy from the mass to settle the diagnosis. Histopathological examination revealed yolk sac tumor. Testicular ultrasound showed a mass with ill-defined hypoechoic areas and lobulated margins in left testis, which was missed on clinical examination. Serum lactate dehydrogenase (LDH) and alpha fetoprotein (AFP) levels were found to be elevated. Beta-human chorionic gonadotropin (β-hCG) was normal. The final diagnosis of nonseminomatous germ cell tumor with mediastinal metastasis was made. The present case underlines the importance of good clinical examination, an art which is diminishing with availability of sophisticated investigations and a thin line of difference between potentially curable and fatal diagnosis, especially in young population, where malignancy is overlooked as a differential diagnosis. Furthermore, despite all its advantages, too much reliance on FNAC may be responsible for misdiagnosis in certain cases.

Abstract TMEM-024: CHARACTERIZATION OF STEM CELLS IN HIGH GRADE SEROUS OVARIAN CARCINOMA CELLS

Abstract PURPOSE: The objectives of this study are to understand how transcription factors and miRNAs impact stemness in epithelial ovarian cancer (EOC). Our goal is to target EOC cancer stem cells (CSC) in order to arrest disease progression. Ovarian Cancer is the most fatal gynecological diagnosis for women. It is typically treated with surgery and chemotherapy, which is initially successful in that tumors shrink; however, most patients experience relapse. Cancer Stem Cells (CSCs) express a similar set of stem cell markers as pluripotent cells, and are thought to contribute to chemoresistance and relapse. Chemotherapy is effective on differentiated cells of the tumor, however cancer stem cells survive, and have the ability to repair and renew the tumor. Cancer cells can be re-sensitized to chemotherapy if stem cells are targeted. Several stem cell markers are expressed in advanced ovarian malignancies. We study the effect of the epithelial to mesenchymal transition (EMT) on stemness. During EMT, cells acquire mesenchymal characteristics and lose epithelial ones. EMT is caused by SNAI1 and other transcription factors that repress epithelial and adhesion molecules such as E-cadherin. EMT results in a stem cell-like phenotype in breast cancer. There is evidence that the EMT factor SNAI1 represses the miRNA let-7, which we hypothesize results in a higher proportion of CSC in EOC cells. Let-7's major function is to promote terminal differentiation and tumor suppression by targeting oncogenes and pluripotency factors. EXPERIMENTAL PROCEDURES: We performed flow cytometry for CD133, CD44, CD117, and aldehyde dehydrogenase to determine proportion of positive cells using published markers. q-RT-PCR was used to determine expression of pluripotency markers Oct4, Lin28 and Nanog. We used immunofluorescence microscopy to identify CSCs. Using a panel of biomarkers specific to CSCs we labeled for SNAI1, NANOG, LIN28A, OCT4, SSEA4, ALDH, TRA1-60, CD133, E-CAD, and N-CAD followed by fluorescent secondary antibodies and nuclear labeling with DAPI. We characterized three epithelial ovarian cell (EOC) lines (OVCAR8, OVSAHO, and COV 318) and patient-derived cells, with and without Snai1 manipulation. RESULTS: Cells were positive for stem cell markers to varying degrees. OVCAR-8 was positive for LIN28A, NANOG, CD44, and ALDH; OVSAHO for Lin 28a and ALDH; and COV318 for NANOG and ALDH. OVSAHO displayed most epithelial (E) characteristics, COV318 and patient samples were most mesenchymal (M), and OVCAR8 appeared to be a M/E hybrid. There was imperfect correlation between mRNA and protein expression of pluripotency markers. CONCLUSIONS: Higher expression of Snai1 correlates with a stem cell phenotype on a population level. On a single cell level, most Nanog-positive cells are Snail positive. However, no ovarian cancer cell perfectly mirrors the pluripotent marker expression seen in NCCIT, our positive control. SNAI1 is a potential target for therapy targeting ovarian cancer stem cells. Citation Format: Maricela Gallardo, Alyse Huisken-Hill, Hanmin Wang, Christine Castanon, Juli J. Unternaehrer. CHARACTERIZATION OF STEM CELLS IN HIGH GRADE SEROUS OVARIAN CARCINOMA CELLS [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr TMEM-024.

FRII-12 UROLOGIC DISEASE DURING THE AMERICAN CIVIL WAR

You have accessJournal of UrologyHistory of Urology: History Forum1 Apr 2017FRII-12 UROLOGIC DISEASE DURING THE AMERICAN CIVIL WAR Patrick Fisher Patrick FisherPatrick Fisher More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2461AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Civil War marked a major turning point in American epidemiology and medicine. Regulations at the start of the Civil War required the senior medical officer of each hospital, post, regiment, or detachment, to make monthly reports to the Surgeon General of the sick and wounded, deaths, and discharges. Urologic infectious, benign and traumatic diagnoses were documented along with other diseases across geographic and racial divides. Using primary documents and epidemiologic data, we attempt to reconstruct the state of urologic disease among soldiers during the War. METHODS Primary documents from the UC Davis Blaisdell Civil War Medicine Collection including the epidemiological tables of sickness and mortality from the Medical and Surgical History of the War of the Rebellion by Surgeon General Joseph K. Barnes were analyzed. A non-systematic review of Pub Med was also conducted. RESULTS In addition to ushering in new paradigms for the military hospital system, trauma surgery, and anesthesia, the Civil War also brought about major improvements in the way diseases were categorized and recorded. Data from the Medical and Surgical History of the War of the Rebellion demonstrates a small but significant burden of genitourinary pathology in the troops across the Atlantic, Central and Pacific Regions. Among GU diagnoses, sexually transmitted infections including syphilis, gonorrhea and orchitis had the highest incidence, averaging 33, 43 and 6 annual cases per 1000 white troops. The incidence of GU pathology was similar between white and non-white troops, with the exception of venereal disease, which was reported more frequently in whites. Venereal disease had a higher incidence at the start and end of the war. Prostitution, which has been well documented, was a likely contributor to the spread of venereal disease. The incidence of stones, benign scrotal disease, testis tumors and urethral strictures was relatively low and stable over the course of the war; surprisingly, of all GU diagnoses, varicoceles were associated with the highest rates of discharge from service. In this pre-penicillin era, the most fatal diagnoses were syphilis and infectious nephritis and cystitis. As previously described by Herr, traumatic GU injuries were relatively uncommon, representing <1% of all battle wounds; however, about half of injuries to the bladder and kidney were fatal and these injuries were fraught with complications such as fistulae. CONCLUSIONS Urologic pathology played a small but significant role in the lives of soldiers during the Civil War. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1071 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Patrick Fisher More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...