Real Entity Research Articles

Follicular neoplasm of the thyroid—vanishing cytologic diagnosis?

The significance of making a diagnosis of follicular neoplasm on fine needle aspiration (FNA) biopsy remains a controversial issue, considering that the diagnosis of follicular carcinoma is based on histological criteria and the significantly decreasing incidence of follicular carcinoma in the general population. On FNA the main differential diagnoses of follicular neoplasm includes follicular variant of papillary carcinoma (FVPC), follicular adenoma, follicular carcinoma and benign solitary nodule occurring in a goiter. Several studies have looked at immunohistochemical and molecular markers to distinguish benign from malignant lesions but none of them have proved to be infallible. Although, FVPC is a distinct entity from the follicular neoplasm group, it is not always possible to separate it from the other follicular lesions because of overlapping cytologic features and often-sporadic presence of nuclear features, follicular variant of papillary carcinoma remains the main pitfall in a diagnosis of follicular neoplasm. Since a significant number of cases that are malignant on follow-up are usually FVPC, consequently, follicular neoplasm is an essential diagnostic consideration on FNA. In addition, follicular carcinoma, despite a decreasing incidence continues to be a real entity. Therefore, it is essential that follicular neoplasm continue to be part of our diagnostic repertoire.

Radiation-induced GH neurosecretory dysfunction might not be a real entity

Radiation-induced GH neurosecretory dysfunction might not be a real entity

Late Restenosis Following Sirolimus-Eluting Stent Implantation

Despite encouraging results from randomized trials, concerns exist about long-term results of sirolimus-eluting stent implantation. We sought to determine whether in-stent restenosis occurring >1 year ("late") after sirolimus-eluting stent implantation is a real clinical entity. We analyzed data on all sirolimus-eluting stents implanted in our institution before March 2003. During the study period 928 lesions in 433 patients were treated. Angiographic follow-up was performed in 306 patients (70.6%) with 679 lesions (73.2%). Angiography after 1 year was performed only in symptomatic patients. We considered restenosis "early" if it occurred during the first year and late if after 1 year. Late restenosis required demonstration of a widely patent stent at 6 to 9 months, with repeat angiography after 1 year demonstrating restenosis. Restenosis occurred in 160 lesions overall (23.5%). Of the 31 (4.6%) that were documented after 1 year, 13 were excluded from analysis due to absence of 6- to 9-month angiography; the remaining 18 (2.6%, 1.7 to 4.2) fulfilled our criteria for late restenosis (median time of documentation 607 days, interquartile range 511 to 923). In conclusion, late restenosis is an infrequent but real entity; its existence implies we should not discount the possibility of restenosis as the cause of symptoms that develop >1 year after sirolimus-eluting stent implantation.

TN11 RENAL ALLOGRAFT COMPRESSION SYNDROME: A REAL ENTITY

Renal allograft compression syndrome (RACS) is being increasingly recognised as cause of early allograft dysfunction.Aim To assess the validity of RACS.Methods Clinical and laboratory findings used to diagnose RACS included acute allograft dysfunction (+ oliguria), duplex ultrasound demonstrating diminished, or reversed diastolic flow within interlobar and segmental arteries and, biopsy showing absence of acute rejection or toxicity. Final diagnosis was made at urgent laparotomy. Observations of poor allograft colour and perfusion after reopening the retroperitoneum were considered confirmatory for RACS.Results Series includes 2 males and 1 female patients. Time elapsed between transplantation and RACS diagnosis was 24–48 hrs. After surgical decompression the allograft perfusion improved visibly in two patients and these cases were then closed with PTFE mesh hood closure. There was no significant improvement observed in the third case that had a renal vein thrombus, which ultimately led to the demise of the graft. Beneficial clinical results were obtained in two cases documented by a sustained decrease in creatinine. Average follow‐up was 9.5 months without any allograft dysfunction.Conclusions RACS is a real entity with a potential to cause graft loss. Kidney can be salvaged by urgent surgical decompression and PTFE mesh closure.

Une cause rare d'œdèmes : l'hypoprotidémie de la gastrite lymphocytaire exsudative

Diagnosis of edema secondary to hypoprotidemia but without nutritional, renal, hepatic or cardiac cause, must consider exsudative digestive disease, of which the lymphocytic gastritis, as the authors report here a new observation diagnosed in a 73 year-old woman. Gastroscopy reveals varioliform gastritis and biopsy demonstrates diffuse infiltration of the gastric epithelium by lymphocytes, making of it a real histopathologic entity among the gastropathies. Etiology and pathogeny remain still unknown but proton pump gastric inhibitors are an effective treatment.

Cool tools: Polysemic and non-commutative Nets, subchain decompositions and cross-projecting pre-orders, object-graphs, chain-hom-sets and chain-label-hom-sets, forgetful functors, free categories of a Net, and ghosts

Expressive tools work primarily on the problem of the clarity and style of expression of models in some underlying theory. There is a structure among mathematics, a theory of the world (e.g. music), expressive constructs with their own structure, the applied theory, and models of some real entity. Lewin's transformational networks are expressive tools of great currency in music theory. We generalize Lewin-nets to Nets, which, unlike Lewin-nets proper, are both polysemic and non-commutative. We show how all kinds of Nets work on both simple and complex data objects, and how this is all useful in expressing musical analysis. We then show some ways that Nets connect with category theory and topology. We construct chain-hom-sets and chain-label-hom-sets in Nets that form free categories on object-graphs and transformation-graphs, and show how each chain-hom-set of paths consists of all possible musical compositions between an initial and final musical object in a chain within a particular Net. We note how the temporal partial order of any piece of music plays against the structural pre-order of its Net representation, and how the various partial and pre-orders cross-project against one another. There is a family of forgetful functors that relate the various categories Net, Object-graph, Transformation-graph, and Grph. We show how to get from both proper Lewin-nets and from Nets to an underlying pre-order such that the labelling arrows of the Net can then be construed as a pre-sheaf over the pre-order. We point out the interesting ghosts that survive all the forgetful functors, that is, the particular characterizing structures of each digraph (or transformation-graph or object graph) which then, reading upwards, constrain the possibilities for labelling its arrows and nodes in any superior entity (such as a Net) built on it.

A Signal Explanation for the Electromagnetic Induction Law

We suggest to interpret the electromagnetic as a received electric signal, following a reasoning parallel to that of J. Clerk Maxwell that led to Faraday's law equation. Usually, the solutions of the entire set of equations for electromagnetism are interpreted energet- ically. The law of equation in particular, was interpreted in an energetic sense by Lenz. The interpretation we present is alternative to his one. The reason why we propose it is the con- viction that telecommunications could take advantage of an interpretation of electromagnetism, updated for the technologies now in use. 1. INTRODUCTION M. Faraday calls \magneto electric induction the coupling between a magnet and a piece of metal wire through a vacuum, when detected as transient electric excitation at the terminals of the wire. Before him, among other people, B. Franklin, inventor of the lightning conductor, had anticipated a connection between electricity and magnetism. Already lightning itself can be considered an electric transient that magnetizes metallic objects: cutlery has been said to have been magnetized by lightning. With respect to this experience, the electric excitation observed in the laboratory as an efiect of the movement of a magnet is just a small transient. For us however, Faraday's experiments are more fundamental, because Maxwell was able to connect them to the knowledge his contemporaries had. In the 19th century substantially two interpretations of the speciflc relation between electricity and magnetism gained ground. The flrst, that we might call (A), is more traditional for those days. This describes the magnetic action at a distance in dynamical terms. To discuss action and reaction between magnet and circuit it establishes the equivalence of a magnetized body and a distribution of current by providing a magnetic representation of the electric current. According to Ampµere, the magnetic dipole moment of a circuit with respect to the origin is given by mel = 1 I H r£dl where r is the radius vector from the origin to the point of observation and dl is an element of the electric circuit having an oriented loop. The mechanical action of B on mel is evaluated as a torque t = mel £ B = dD=dt, where D = mr £ v is the angular moment. This formally admits an electric equivalent thanks to the formula mel / IAn, which originates from the representation of the circuits with magnetic shells, of use for calculation of the magnetic potential according to Poisson. Here n is a versor normal to the shell. Hence the magnetic expression for the torque becomes: dmel=dt / mel £ B, or dM=dt / M £ B, where the magnetization M is deflned as a sum over the unit volume of molecular dipole moments mel. H. Lenz suggested that the force due to the magnet may induce within metals, besides the torque, also Faraday's non-mechanical transient ∞ow of electricity. According to the second interpretation of induced current, (B), the magnetic fleld is rather an emanation of the magnet. The electric transient at the terminals of a coil is generated in response to a change of the magnetic ∞ux ' linked with it, that is d' … d(AB), where A is the area enclosed by the coil, and B is the ∞owing magnetic quantity. Whether we conceive of B as a real entity or not, the displacement of the magnet induces in the circuit a current I exactly as would connecting a battery: UK = iLdI=dt, with ' = LI and L the inductance of the wire loop.

The potential role of high or low birthweight as risk factor for adult schizophrenia

Obstetric complications may be an important factor in the development of schizophrenia. The aim of this study is to evaluate the role of these complications in the development of schizophrenia in adult life, with particular attention to the potential role of birth weight. We carried out a case-control study, comprising schizophrenics and patients with diseases of the schizophrenia spectrum as cases, and their healthy male brothers as controls. Obstetric complications were assessed using the "Midwife Protocol" of Parnas et al. The main result was that birth weight may be a risk factor for schizophrenia, as indicated by odds ratio analysis. The confidence intervals are very wide and, without compromising the clinical significance of the results, they give a limited indication of the real entity of the risk. The results contribute to understanding of the role played by a single complications.

Alcaptonuria with lumbar disc prolapse: case study and review of the literature

Background context Patients with alcaptonuria frequently complain of pain in the large joints and the spinal column, this condition is being assumed to be normal. It is very rare for patients with ochronosis to undergo lumbar surgery since the disk protrusion is not characteristic for them and overlaps with the general complaints due to the spondiloarthritic and stenotic changes. Purpose To prove the possibility of a lumbar disc herniation in a patient with alcaptonuria as a real entity that causes lumbar and radiculalgic complaints. Study design A case of a 33-year old patient with alcaptonuria and lumbar disc herniation is presented. Methods The case is presented together with its clinical course, the diagnostic techniques, the surgical findings, histological results and the treatment outcome. Results After the surgical treatment the patient's complaints were alleviated and almost no complaints were registered, during the next follow-up. Conclusions The most common symptoms seen in alcaptonuria are complaints of pain in large joints and back pain. They are usually associated with the main disease. The case we present demonstrates that even there is a small likelihood for a prolapsed lumbar disk, it should be sought in such patients as the surgical treatment is able to yields a positive results.

Evolutionary psychiatry and the schizophrenia paradox: a critique

Evolutionary psychiatrists invariably consider schizophrenia to be a paradox: how come natural selection has not yet eliminated the infamous ‘genes for schizophrenia’ if the disorder simply crushes the reproductive success of its carriers, if it has been around for thousands of years already, and if it has a uniform prevalence throughout the world? Usually, the answer is that the schizophrenic genotype is subject to some kind of balancing selection: the benefits it confers would then outbalance the obvious damage it does. In this paper, however, I will show that the assumptions underlying such evolutionary accounts of schizophrenia are at least implausible, and sometimes even erroneous. First of all, I will examine some factual assumptions, in particular about schizophrenia’s impact on reproductive success, its genetics, its history, and its epidemiology. Secondly, I will take a critical look at a major philosophical assumption in evolutionary psychiatric explanations of schizophrenia. Indeed, evolutionary psychiatrists take it for granted that schizophrenia is a natural kind, i.e. a bounded and objectively real entity with discrete biological causes. My refutation of this natural kind view suggests that schizophrenia is in fact a reified umbrella concept, covering a heterogeneous group of disorders. Therefore, schizophrenia, as we now know it, simply doesn’t have an evolutionary history.

Prehypertension-What Is It and Should It Be Treated?

In May 2006, a panel of experts was assembled during the meeting of the American Society of Hypertension, Inc to discuss the diagnosis and treatment of prehypertension. Is it a real entity? Does it pose a risk? Should it be treated entirely with lifestyle interventions or should some patients be placed on pharmacologic therapy? The panel was chaired by Dr Marvin Moser, Clinical Professor of Medicine at the Yale University School of Medicine, New Haven, CT, and Editor in Chief of The Journal of Clinical Hypertension. Panelists included Dr Thomas Giles, Professor of Medicine at Louisiana State University, New Orleans, LA; Dr Joseph Izzo, Jr, Professor of Medicine at SUNY Buffalo School of Medicine, Buffalo, NY; and Dr Henry Black, Roberts Professor of Preventive Medicine at the Rush University School of Medicine in Chicago, Chicago, IL.

Non‐erosive reflux disease, functional heartburn and gastroesophageal reflux disease; insights into pathophysiology and clinical presentation

Non-erosive reflux disease (NERD) has emerged as a real entity in the spectrum of gastroesophageal reflux disease (GERD) and may, indeed, represent the most common manifestation of reflux disease. Recent information indicates NERD can be further subclassified based on the results of pH studies and suggests that functional heartburn needs to be differentiated as that subgroup of patients in which there appears to be no relationship between symptoms, however 'typical' of GERD, and acid exposure. Other aspects of NERD need to be appreciated, including overlap with functional dyspepsia and the potential variations in response to such therapeutic interventions as acid-suppressive therapy and fundoplication. It seems quite possible that our failure to separate functional heartburn from NERD, in general, has contributed, in large measure, to diagnostic difficulties and therapeutic disappointment in GERD. An appreciation of the range of entities, of different etiology and pathology, within NERD will foster the development of effective approaches to the assessment and therapy of this challenging disorder.

Fracture de la vis cervicale d’une vis-plaque à glissement: À propos d’un cas à 1,5 an de recul

Although no cases have been reported to date, fracture of a sliding hip screw on a screw-plate fixation is a real entity since material watch registries have revealed two non-published cases. We report an illustrative case. A 67-year-old man was hospitalized for a right intertrochanteric fracture. The patient was treated with a sliding hip screw plate fixation (short cannon, 105 mm screw). On the eighth postoperative day, fracture impaction was present with complete loss of impaction reserve associated with secondary discrete divergence in the cannon-screw alignment. Weight-bearing was postponed until the 45 th postoperative day. At three months, bone healing had not been achieved. A clear image was also visible at the plate end of the cannon. The patient complained of persistent pain but there were no signs of infection. At the fifth month, the patient fell from the standing position and standard x-rays visualized the nonunion of the intertrochanteric fracture plus a infratrochaneric diaphyseal fracture line in addition to a fracture of the sliding hip screw. The plate screws were intact. The patient underwent revision osteosynthesis with a Medoff plate. Fracture of a sliding hip screw is a rare event. In the present case, the mechanism involved an insufficient impaction reserve and use of a short cannon. Treatment requires extraction of the distal fragment of the screw and a new cemented osteosynthesis.

Is the metabolic syndrome a real clinical entity and should it receive drug treatment?

Metabolic syndrome represents a cluster of risk factors commonly associated with obesity and diabetes that in turn are associated with an increased risk of cardiovascular disease. The worldwide prevalence of metabolic syndrome, obesity, and diabetes is on the rise, leading to serious public health concerns surrounding the downstream consequences in the form of premature cardiovascular disease. In this review, we examine the debate surrounding the characterization and diagnosis of metabolic syndrome and discuss potential treatment options.

Brain damage as detected by magnetization transfer imaging is less pronounced in benign than in early relapsing multiple sclerosis

The trend to start disease-modifying therapy early in the course of multiple sclerosis makes it important to establish whether the benign form is a real entity. In previous studies, measures of magnetization transfer (MT) ratio (MTr) have been shown to provide good estimates of the amount of tissue damage occurring in multiple sclerosis brains. Thus, with the hypothesis that if benign multiple sclerosis patients were really benign, sensitive measures of subtle tissue damage would be less pronounced in these patients than in very early relapsing-remitting (RR) multiple sclerosis patients. We carried out conventional MRI and MT imaging in 50 patients with benign multiple sclerosis [defined as having Kurtzke Expanded Disability Status Score (EDSS) <3 and disease duration >15 years] and in 50 early RR patients selected to have similar disability (EDSS <3) and short disease duration (<3 years). Data were compared with those of 32 demographically-matched normal controls. We used a fully automated procedure to measure lesional-MTr, perilesional-MTr, normal-appearing white matter (NAWM) MTr and cortical-MTr. We found that, after correction for common effects of age, lesional-MTr and perilesional-MTr of benign patients were significantly (P < 0.0001) lower than WM of normal controls, but significantly (P < 0.0001) higher than corresponding tissues of RR patients. In NAWM and cortex, MTr values of benign patients were similar to those of normal controls (P > 0.5) and significantly higher than those of the RR patients (P < 0.0001 and P < 0.01, respectively). Similar differences in MTr measures between benign and RR patients were found when patient groups were selected to have no disability (EDSS < or = 2) and, for benign multiple sclerosis, very long disease duration (>20 years) or when both groups were matched for high lesion load (T2-weighted lesion volume >10 cm3). We conclude that lesional and non-lesional MTr values can be significantly less pronounced in benign multiple sclerosis than in a cohort of RR patients at their earliest disease stages, suggesting that brain tissue damage is milder in benign multiple sclerosis than in early RR disease. This can be due to an extraordinary beneficial response to demyelination of benign patients and may represent the evidence that benign multiple sclerosis truly exists and might be differentiated from other forms of this illness.

The Structure of Time: Language, Meaning and Temporal Cognition (review)

Reviewed by: The structure of time: Language, meaning and temporal cognition by Vyvyan Evans Brigitte Nerlich The structure of time: Language, meaning and temporal cognition. By Vyvyan Evans. Amsterdam: John Benjamins, 2004. Pp. 287. ISBN 158811466X. $114 (Hb). ‘Everyone knows about time. We have spare time, we gain time, we lose time. We mark time, keep time, play for time, but in the end time waits for no one. You can tell the time from a clock, but few people can handle the really tricky time question’ (Arnold 2002:5, italics added). So what can we learn from this book? Reading the book was a bit like untying a ball of knots one after the other until, by Ch. 5, I was able to follow a much smoother line of thought and explanation. The book has three parts: orientation, concepts for time, and models for time. The books starts with an explanation of what physicists and philosophers call the realist or absolutist view of time, that there is ‘true’ time, a time that actually exists in a physical sense and agrees with the laws of nature. Evans calls this the ‘common-place view of time’. This is only one way that physicists conceptualize time, though there are several others (see Callender & Edney 2001). E explains that this view of time seems to be contradicted in two ways: (i) by our feeling that time is elusive and imperceptible, and (ii) because there does not appear to be a neurological apparatus that enables us to perceive global time (4). This gives rise to what he calls the metaphysical problem of time, which can be summarized as: time exists and does not exist at the same time. His book intends to refute the physicalist view of time but also the view that time is an abstraction derived from comparing events, a view espoused by some cognitive linguists. E’s own hypothesis is that time is neither a physical entity nor an abstraction, but that our awareness of time is based on perceptual processes and phenomenological experience, that temporality is fundamentally internal, although derived from responses to the external world of sensory experience. E uses the terms ‘time’ and ‘temporality’ interchangeably. It might have been helpful to assign them different roles, especially as E seems to vacillate in his argumentation between criticizing and/or espousing views put forward by those who have tried to fathom the ‘nature of time’ and those that have tried to fathom the ‘nature of the perception of time’ or the ‘nature of the experience of time’. In this context a distinction between the experience of temporality and time ‘out there’ (whatever it might be) is essential (see p. 8, where E writes: ‘our experience of time cannot be equated with an objectively real entity inhering in the world “out there”’—no it cannot because it is an experience). ‘The ultimate goal of this book is to establish the nature and structure of time, in essence to resolve the metaphysical problem’ (5). To do this E tackles the linguistic problem of time. By uncovering the structure of concepts of time (through a study of the various senses the lexeme time has acquired in English) E hopes to shed light on the structure of time itself—a rather big and perhaps confounded claim. E argues furthermore that ‘as language reflects conceptual structure in important ways, it accordingly represents a crucial window into the human conceptual system’ (5)—a rather circular argument. Like all cognitive linguists, E looks at meaning through the lenses of conceptualization, cognition, and ultimately embodiment, in this case neurologically based temporal and perceptual processes. Following Ronald Langacker, language is regarded as a symbolic process whereby a physical symbol is paired with a meaning element or concept. E is particularly interested in one subset of concepts, namely lexical concepts. Meaning and conceptualization are collapsed in this view. This approach normally overlooks the social dimension of ‘meaning’ (which might shed light on how this rather miraculous ‘pairing’ happens), but E later addresses this issue. Those who believe in the ‘primacy of pragmatics’ might want to argue that meaning does not exist—it happens in social interaction and in time. The...

Power, Ownership and Entity: Some Issues on the Nature of the (Network) Firm

The firm was evicted from economic analysis for a long time. It appeared as a particular and substantial scope thanks to the economist R.H. Coase at the end of the 1930'S but sunk into oblivion for three decades. This paper deals with the 1970's renewal of interest in the theory of the firm, particularly from the development of new institutional economics. But we argue that these contractual approaches need to be refined by considering - as Rajan and Zingales argue - the impacts of financial revolution and of the valuation of human capital on firm performance. Some alternative theories - based on critical resources or competences - become more and more evident to analyze the nature and the boundaries of the firm. This one conceals - beyond the metaphor of the nexus of contracts - the features of a real entity. In this article, we want to shed light on the crossed-fertilization effects between these theories in order to raise the issue of the boundaries of the firm and to dissociate the legal and economic nature of the firm. It is hence suitable to deal with the theoretical analysis of the network-firm. The characterization of this complex organizational form, which is coordinated by a hub-firm that has a power over other legally independent firms without recourse to equity ownership, allows us to reveal both the nature of interfirm cooperation and its implications on the theory of the firm. Finally, we propose a conception of the firm based on power.

Neutrophilic fixed drug eruption caused by naproxen: A real entity or a stage in the histopathologic evolution of the disease?

To the Editor: We herein report a rare case of neutrophilic fixed drug eruption (FDE) with naproxen as a novel causative agent. A 51-year-old white woman presented with multiple indurated pruritic plaques on her hands (Fig 1) and erosions on the lower lip mucosa (Fig 2) following the ingestion of a 275 mg tablet of naproxen (Apranax; Roche, Basel, Switzerland). This was her fourth attack during the last 5 years. Histopathology of the skin lesions revealed intense neutrophilic exocytosis resulting in intraepidermal pustule formation, similar to another recently reported case.

Extraspinal osteoarticular tuberculosis: a forgotten entity?

Tuberculosis affects a significant percentage of the world's population and is responsible for bone and joint infections particularly in the developing world. The problem has been compounded by the HIV/ AIDS epidemic. Whereas tuberculous involvement of the spine is readily included in a list of differentials for destructive lesions of the spine, infection in other skeletal areas is often not considered. In endemic areas, physicians are aware of the clinical and radiological presentations of musculoskeletal tuberculosis. In non-endemic areas, this knowledge is often lacking. Diagnostic delay often results in increased morbidity and mortality. There is a need therefore to highlight extra-spinal osteoarticular tuberculosis as a real entity.

A Compact Macromodel of World System Evolution

The fact that up to the 1960s world population growth had been characterized by a hyperbolic trend was discovered quite some time ago. A number of mathematical models describing this trend have already been proposed. Some of these models are rather compact but do not account for the mechanisms of this trend; others account for this trend in a very convincing way, but are rather complex. In fact, the general shape of world population growth dynamics could be accounted for with strikingly simple models like the one which we would like to propose ourselves: dN/dt = a (bK – N) N (1); dK/dt = cNK (2), where N is the world population, K is the level of technology/knowledge, bKcorresponds to the number of people (N), which the earth can support with the given level of technology (K). Empirical tests performed by us suggest that the proposed set of two differential equations account for 96.2– 99.78% of all the variation in demographicmacrodynamics of the world in the last 12,000 years. We believe that the patterns observed in pre-modern world population growth are not coincidental at all. In fact, they reflect population dynamics of quite a real entity, the world system. Note that the presence of a more or less well integrated world system comprising most of the world population is a necessary precondition, without which the correlation between the world population numbers generated by hyperbolic growth models and the observed ones would not be especially high. In fact, our findings could be regarded as a striking illustration of the fact well known in complexity studies — that chaotic dynamics at the microlevel can generate a highly deterministic macrolevel behavior. Against this background it is hardly surprising to find that the simplest regularities accounting for extremely high proportions of all the macrovariation can be found just for the largest possible social system — the world system.