Undefined Cases Research Articles

31 Occupational malignant mesothelioma cases; Review by Dutchpulmonologists of undefined cases in the framework of a reimbursement program of the Netherlands Institute of Asbestos Victims

31 Occupational malignant mesothelioma cases; Review by Dutchpulmonologists of undefined cases in the framework of a reimbursement program of the Netherlands Institute of Asbestos Victims

Clinical, genetic, and therapeutic insights into systemic mast cell disease.

Mast cell disease is markedly heterogeneous in its underlying molecular pathogenesis, clinical presentation, natural history, and specific treatment. Skin-only disease (cutaneous mastocytosis) is infrequent in adults and systemic mastocytosis may be broadly classified as an indolent or aggressive variant based on the absence or presence of impaired organ function. Urticaria pigmentosa and mast cell mediator release symptoms can occur in all categories of mast cell disease and may not be prognostically detrimental. The purpose of this review is to summarize current concepts and recent advances in the pathogenesis and treatment of adult mast cell disease. A series of laboratory investigations has revealed that mast cell disease is a clonal stem cell disorder, and at least two genes (c-kit and PDGFRA) with pathogenetically relevant mutations have been identified. FIP1L1-PDGFRA+ mast cell disease responds completely to imatinib mesylate. Both Asp816Val c-kit+ and molecularly undefined cases have been shown to respond to 2-chlorodeoxyadenosine therapy after failing treatment with interferon-alpha. A partial molecular classification of mast cell disease is now possible; Asp816Val c-kit+, FIP1L1-PDGFRA+, and molecularly undefined cases. Such molecular classification is therapeutically relevant.

Medical ethics: its current applications

Ethical codes as practiced in the medical profe,ssion has been recognized since at least 2000 years ago. Medical ethics governing the relationship between physician and patient compise three fundamental principles, i.e., autonomy, values and benevolence, and justice. Ethics in an attempt to undertake an orderly reflection on moral intuiilons made by individual, while medical ethics may be considered as a moral based duty which governs medical practice. The last few decades have witnessed the increasing tendency of perceiving medical ethics as more important than ever. The current concem of society over ethical problems has led the medical profession to elevate its understanding ofthe society's views ofthese problems, andthe current global situation callsfor ethical reflection. At the same time, the advances of science and technology, economic globalization, and radical changes in the society raise moral questions which are unayoidable to us. Although there exist increasing demands for resolving ethical problems more adequately, medical profession must face a great number of still undefined cases. Several typical problems facing physicians include justice and allocation of heahh serttices, duties of the physician toward the patient, standard medical services or standard procedures, experimental and innovative procedures, informed consent, malpractice, and error in judgment. All these represent the problems that will be invariably faced and resolved by the physician.

Polymerase chain reaction can resolve some undefined cases of hepatitis B virus antigenic subtyping.

HBsAg subtypes were defined by means of adsorbed polyclonal antisera; however, HBsAg subtyping is currently usually carried out with monoclonal antibodies (Mab). We developed a complementary subtyping method based on the polymerase chain reaction. Reference samples belonging to all known HBsAg subtypes could be detected and grouped into four different categories (ayw1/ayw4/ayr, ayw2/ayw3, adw2/adrq+/adrq-, adw4). Thirteen HBsAg-positive serum samples previously subtyped as ad by means of monoclonal antibodies fell into the adw2/adrq+/adrq- group, as well as 13 ay samples into the ayw2/ayw3 group. These results could be confirmed by means of reference polyclonal antisera in nine ad cases (all adw2) and in seven ay cases (all ayw3); the remaining seven were below the detection limit of the polyclonal assay. Four samples which were not recognized by any of the d/y subtype-specific Mab were shown to contain ayw2/ayw3 sequences. Only one contained sufficient HBsAg to be confirmed as ayw3 by means of reference antisera. Three of five sera showing simultaneous reactivity both for d and y-specific Mab were classified as adw4 by PCR, as was one by reference polyclonal antisera. The y-specific monoclonal antibody cross-reacted with the adw4 subtype. Single adw2 sequences were amplified in one of the remaining two cases, as well as single ayw2/ayw3 sequences in the other, suggesting that they showed true coexistence of two strains of different subtype, only one of which was in active replication state. It is concluded that the method described is useful in the solution of some undefined cases obtained with the monoclonal-based assays.