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ABSTRACT: Malignant mixed müllerian tumors (MMMT) are highly aggressive tumors, usually diagnosed in advanced stage. Cases of MMMT derive from either ovary or uterus. In our study, we investigated the role of carcinomatous and sarcomatous component on response to chemotherapy and disease outcome. We retrospectively analyzed 25 patients with MMMT who were treated in our outpatient clinic from 1998 to 2003. All the paraffin specimens were reevaluated according to the histopathologic features (primary site and percentages of carcinomatous and sarcomatous component) and the effect of predominant histologic type on response to treatment. Primary tumor sites were ovary and endometrium in 36% and 64% of patients, respectively. Ten of 25 patients (40%) were treated with a combination chemotherapy regimen of cisplatin-ifosfamide (PI) and 7 patients (28%) were treated with paclitaxel-carboplatin (PC) protocol. Despite chemotherapy, 17.6% of patients had progressive disease. The remaining 13 patients (54.2%) responded to chemotherapy. Response rates of patients treated with PC (100%) were remarkably higher than the response rates of patients treated with PI (66.6%). Moreover, patients with predominating carcinomatous component had a higher response rate (87.5%) than patients with predominating sarcomatous component (66.6%). MMMT are highly chemoresponsive tumors, irrespective of primary site. One of the best predictors to response is the histologic pattern. Predominating histopathologic feature (carcinoma or sarcoma) should be taken into consideration in predicting the response and planning the chemotherapy regimen.
International Journal of Gynecological Cancer 10/2007; 18(4):809-12. · 1.65 Impact Factor
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Endoscopy 06/2001; 33(5):472. · 5.21 Impact Factor
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ABSTRACT: The identification of crystals in synovial fluids and joint tissues is the most rapid and accurate method of diagnosing the common forms of crystal-associated arthritis. Although there are numerous methods available for identifying and characterizing crystals in biologic specimens including x-ray crystallography and Fourier transform infrared spectroscopy, in practice, polarizing light microscopy is used almost exclusively for articular crystals. Unfortunately, problems with reliability and reproducibility undercut the usefulness of this simple procedure. This article highlights recent developments in the field and discusses the importance of identifying synovial fluid crystals, proper handling of specimens, and the appropriate use of available technologies for crystal identification.
Current Rheumatology Reports 03/2001; 3(1):11-6.
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ABSTRACT: Tuberculosis may be difficult to diagnose when it presents in an uncommon extrapulmonary site. The authors report a case of splenic tuberculosis mimicking metastatic tumor on computed tomography in a 60-year-old woman who had been treated with combination chemotherapy for nasal angiocentric lymphoma. Diagnostic splenectomy revealed multiple necrotic masses in the spleen, which were consistent with caseating granulomas microscopically. Diagnosis was confirmed by positive cultures in Lowenstein medium, which grew typical Mycobacterium tuberculosis organisms. Following splenectomy, the patient was also treated with a triple-drug antituberculosis regimen with no recurrence of her symptoms.
Journal of Clinical Gastroenterology 08/1999; 29(1):96-8. · 3.16 Impact Factor
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ABSTRACT: Bone marrow involvement is a frequent finding in malignant lymphoma. Bone marrow biopsy of the posterior iliac crest is routinely performed for staging. Abnormal magnetic resonance imaging (MRI) signals of bone marrow was also reported to be indicative of bone marrow involvement. This study included 60 patients with malignant lymphoma. Unilateral bone marrow biopsy of the posterior iliac crest was performed. MRI of lumbar spine was studied within 24 hours of bone marrow biopsy. 22 healthy controls were used for the detection of MRI objectivity during visual evaluation. In 83% of patients (50/60), biopsy and MRI results agreed completely. In two patients, histologic sections failed to show any evidence of bone marrow involvement despite abnormal MRI signals suggestive of involvement. In three patients, MRI was completely normal despite biopsy proven bone marrow infiltration. False negativity (3/60) and false positivity (2/60) rates were very low. Negative biopsy findings with positive or equivocal MRI results should not exclude bone marrow involvement and needs further evaluation with bilateral or guided biopsy. Thus, we conclude that MRI of bone marrow is a fairly sensitive, noninvasive modality and might be of potential value in detecting bone marrow infiltration in malignant lymphoid neoplasms which can be utilized as a useful adjunct to standard staging procedures.
Pathology & Oncology Research 02/1999; 5(2):123-8. · 1.37 Impact Factor
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ABSTRACT: Calcium crystals in osteoarthritic (OA) joints promote enzymatic degradation of articular tissues. Matrix vesicles provide a nidus for calcium crystal formation in chick epiphyseal and mature porcine articular cartilage. In order to examine a potential role for matrix vesicles from OA cartilage in generating pathologic crystals, we sought to determine whether vesicles derived from human OA cartilage (OAMV) could mineralize; and we characterized the resultant mineral species. OAMV were isolated and examined for alkaline phosphatase (AP) and nucleoside triphosphate pyrophosphohydrolase (NTPPPH) activity. OAMV ATP-dependent and independent mineralization were measured in a radiometric biomineralization assay, and newly formed OAMV crystals were examined using Fourier transform infrared spectroscopy (FTIR) and compensated polarized light microscopy. The mean specific activity of OAMV AP was approximately 6 times higher and NTPPPH activity 11 times lower than that of previously characterized, mature, porcine, articular cartilage vesicles. OAMV progressively precipitated 45Ca over time both in the presence and absence of ATP. The FTIR spectra of mineral formed in ATP-dependent assays most closely resembled the standard spectrum for calcium pyrophosphate dihydrate (CPPD). The FTIR spectra of OAMV mineral formed in the absence of ATP closely resembled apatite. These data support the hypothesis that OAMV may form mineral phases of two key crystals found in degenerating cartilage and provide further evidence for the role of matrix vesicles in pathologic articular cartilage biomineralization.
Calcified Tissue International 10/1998; 63(3):258-62. · 2.38 Impact Factor
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N Mandel
The Journal of Urology 02/1997; 157(1):2. · 3.75 Impact Factor
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N Mandel
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ABSTRACT: Urinary tract stone formation is a multifaceted process. Urinary tract stone crystalline components are of six types: calcium oxalate, calcium phosphate, bacterial related, purines, or cystine. The majority of urinary stones are admixtures of two or more components, with the primary admixture being calcium oxalate with apatite. The formation of urinary tract stones is a result of increases in urinary supersaturation and the subsequent formation of crystalline materials. The mechanism of formation of crystalline particles in the urine is based on the thermodynamic state of the urine chemistry. The natural progression of the urine chemistry leading to stone development is urine saturation, urine supersaturation, crystal nucleation, aggregation, the retention of crystals by the urothelium, and the continued growth of the stone on the retained crystals. When the concentration of the salt components increases beyond the saturation level, a state of supersaturation exists in the urine, which is thermodynamically unstable. Supersaturation leading to nucleation is controlled by the thermodynamic free energy of the solution. The process of nucleation results in a reduction of excess free energy to a more thermodynamically stable environment. Aggregation appears to be the major mechanism for crystal growth. A final factor that is important in the effective growth of renal calculi is the retention of microcrystals in the urinary tract, possibly correlated with prior injury.
Seminars in Nephrology 10/1996; 16(5):364-74. · 2.12 Impact Factor
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ABSTRACT: To assess the ultrasonographic appearance and associated pathological changes of the endometrium in postmenopausal breast cancer patients with tamoxifen therapy.
Forty-eight postmenopausal breast cancer patients receiving 20 mg/day tamoxifen for 6-84 months (mean 29) and 38 control breast cancer patients without any hormonal treatment were examined by transvaginal ultrasonography and endometrial biopsy. Any thickening of the endometrium with cystic formations or homogeneous endometrial thickening > 10 mm detected by ultrasonography was defined as abnormal endometrial appearance. Homogeneous endometrial thickening < 10 mm without cystic formations was accepted as normal. Statistical analysis was performed using the Student's t-test and Mann-Whitney U test.
The two groups were similar in age and menopausal period. The patients on tamoxifen therapy had a thicker endometrium (8.6 +/- 6.6 mm) than the non-treated women (4.8 +/- 3.1 mm), which was found to be a statistically significant difference (P < 0.01). The sonographic evaluations showed abnormal endometrial appearance in 8 cases of tamoxifen treated women while the others revealed homogeneous thickness < 10 mm without cystic formations or a thin linear echo with or without fluid in the endometrial cavity. All 8 patients with cystic appearance had endometrial thickness > 10 mm. Only 1 patient had endometrial cancer on biopsy and no pathology was observed in the remaining 7 patients. In the control group, only 1 patient had abnormal ultrasonographic finding who had insufficient endometrial tissue on biopsy.
Tamoxifen can produce a sonographic image of the endometrium that resembles endometrial neoplasia. It is suggested that the discrepancy between the sonographic findings and histology may be the result of the stromal edema of the endometrium from tamoxifen treatment. Until more data are gathered, all postmenopausal breast cancer patients who are being treated with tamoxifen should have a periodic ultrasonographic examination and those presenting with a sonogram suggestive of endometrial pathology should undergo biopsy.
European Journal of Obstetrics & Gynecology and Reproductive Biology 08/1996; 67(2):157-62. · 1.97 Impact Factor
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ABSTRACT: We previously identified a unique fraction of porcine articular cartilage vesicles, sedimentable at 8 x 10(6) g/min, which generate calcium pyrophosphate dihydrate crystals (CPPD) in vitro. We sought to identify and characterize other fractions of articular cartilage digest, sedimentable at lower g forces, which may also contain mineralizing vesicles.
Electron microscopy and alkaline phosphatase and nucleoside triphosphate pyrophosphohydrolase (NTPPPH) assays were used to analyze each fraction. Radiometric mineralization assays, Fourier transform infrared (FTIR) spectroscopy, and compensated polarized light microscopy were used to analyze crystals formed by these fractions.
Vesicles of varying sizes identical to epiphyseal cartilage matrix vesicles were seen in all sedimentable fractions examined, but were the exclusive component of fractions sedimentable at 3 x 10(6) g/min, termed the heavy vesicle fraction (HVF), and at 8 x 10(6) g/min, now termed the light vesicle fraction (LVF). All vesicle containing fractions supported ATP dependent calcium pyrophosphate precipitation. The HVF and LVF precipitated 30 x more calcium than vesicle poor supernatant (p < 0.01) and 1.5-4 x more than cell-free unfractionated digest (p < 0.01). HVF differed from LVF in that it contained 3-4 x higher NTPPPH specific activity (p < 0.05). HVF resembled LVF in that both precipitated crystals consistent with CPPD by FTIR spectroscopy and compensated polarized light microscopy.
These data expand our previous estimate of the total number of vesicles available for biologic mineralization and demonstrate heterogeneity of vesicle fractions. They support a key role for vesicles in CPPD crystal formation.
The Journal of Rheumatology 08/1995; 22(8):1514-9. · 3.69 Impact Factor
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ABSTRACT: Urolithiasis is a multifaceted process that initiates with the formation of microcrystals in the urine and terminates with the formation of mature renal calculi. The attachment of crystals by the urothelium is a major event in the successful formation of the mature stone. The papillary tip is the primary site for crystal attachment and stone maturation, and the attachment process appears to be mediated by specific molecular interactions between molecular structures on the surfaces of stone crystals and molecular arrays on the surfaces of cell membranes. Animal models have demonstrated the interaction between cells and crystals, and they have suggested a correlation between cellular damage and crystal interaction, especially when crystals bind to and then break free from the tubular epithelium. Cell culture studies on inner medullary late collecting duct (IMCD) cells have demonstrated that calcium oxalate monohydrate, hydroxyapatite, and uric acid crystals bind to IMCD cells in primary culture. The attachment of these crystals to IMCD cells was crystal structure dependent, saturable, and competitively inhibitable if more than one crystal type was present at the same time. The crystals preferentially attach to cells that have lost partial or complete intercellular junctional integrity. These crystal-attaching cells appear to have altered membrane composition and/or structure. Recent studies on red blood cells and IMCD cells that have been enriched with cholesterol and selected phospholipids suggest that crystal-membrane phospholipid interactions play a major role in crystal attachment.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of the American Society of Nephrology 12/1994; 5(5 Suppl 1):S37-45. · 9.66 Impact Factor
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ABSTRACT: Retention of stone crystallites by urothelium is clearly one of the prime requisites for urinary stone disease. Studies in the literature as early as 1937 have highlighted that the initiation of renal calculi followed the formation of subepithelial calcified plaques in the renal pelvis. The renal papilla is one of the primary sites for crystal fixation and stone maturation. We have developed an in vitro model system for the study of kidney stone crystal retention to tubular epithelium using rat renal papillary collecting tubule (RPCT) cells in primary culture. We have qualitatively and quantitatively analyzed the binding of preformed calcium oxalate monohydrate (COM), hydroxyapatite (HA), and uric acid (UA) crystals to RPCT cells. Our goal was to determine if three common urinary stone crystals evidenced different crystal-cell binding characteristics. Also, since these crystals are frequently observed admixed in stones, we have studied the inhibitive binding characteristics of these crystals with RPCT cells. The RPCT cells in culture grow both as the typical polygonal cells in monolayer and as clumps of aggregated cells. The cells in the aggregates are viable epithelial cells that have lost their attachment to the basement membrane, resulting in the exposure of surface molecules that would not normally be present unless the cells were damaged or if there was a loss of intercellular tight junctions. COM, HA, and UA crystals all preferentially bound to the aggregated cells and all exhibited similar saturable binding patterns.(ABSTRACT TRUNCATED AT 250 WORDS)
American Journal of Kidney Diseases 05/1991; 17(4):402-6. · 5.43 Impact Factor
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ABSTRACT: Tissue deposits of basic calcium phosphate (BCP) crystals are associated with various clinical manifestations of inflammation. We addressed the possibility that native proteins modify the ability of hydroxyapatite (HA) crystals to stimulate human inflammatory cells. Neutrophil superoxide release and chemiluminescence in response to HA crystals (0.3-4.0 mg/ml) were blunted by serum and plasma. Inhibitory activity was progressively removed from serum by sequential adsorption with HA crystals, suggesting that the inhibitors were crystal-bound proteins. Thus, we characterized HA crystal-bound plasma proteins by O'Farrell gels: Fibronectin, transferrin, albumin, alpha 2-HS glycoprotein (AHSG), alpha 1-proteinase inhibitor, alpha 1-acid glycoprotein, Gc globulin, haptoglobin, and high density lipoprotein apolipoproteins were major bound species. Of these, AHSG was the most active inhibitor of HA-induced neutrophil superoxide release, and this glycoprotein partially (60%) restored inhibitory activity to HA-adsorbed serum. AHSG also bound in vitro to the related BCP crystal, octacalcium phosphate, but only minimally to calcium pyrophosphate dihydrate crystals and monosodium urate crystals. Suppressive effects on neutrophil stimulation exhibited by AHSG were also specific for BCP crystals. AHSG was present in noninflammatory synovial fluids bound to synthetic HA crystals in vitro, and AHSG could be detected on native synovial fluid HA crystals. We conclude that the binding of AHSG may modulate the inflammatory potential of BCP crystals.
Arthritis & Rheumatism 10/1988; 31(9):1081-9. · 7.87 Impact Factor
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ABSTRACT: The chemistry and molecular bonding characteristics of the CaPPi family of compounds are very complex. The unique molecular flexibility of the PPi anion and the potential variability of Ca coordination geometries have allowed for a broad spectrum of CaPPi type structures. The structure of t-CPPD has the smallest P-OB-P angle of the known CaPPi structures, both Ca atoms are 7 coordinate which is the maximum allowable contacts for Ca atoms, and the two water molecules of crystallization not only serve to fill molecular space, but they are also involved in direct contact to the PPi anions and the Ca atoms. The structure of t-CPPD appears to be very stable and the structural characteristics support the observation that the crystals are sparingly soluble in an aqueous environment. Unfortunately, the structure of m-CPPD is not known and comparisons cannot be made. The solution model studies have resulted in the observation that t-CPPD and m-CPPD crystals can be grown in an aqueous environment at conditions far less harsh than those required for the standard synthetic procedure. However, the synthetic procedure, in contrast to the solution models, yields the prismatic crystal growth morphology of t-CPPD and the rod morphology of m-CPPD observed in vivo. The solution models showed that increasing Mg or Pi retarded crystal formation. At physiologic levels of Mg and Pi, a-CaPPi formed, but neither t-CPPD nor m-CPPD would form. In all solution studies, the final Ca and PPi were not determined and therefore a correlation could not be made between the ionic concentrations and crystal type formed. The gel models using silica, polyacrylamide, and biologic grade gelatin all highlighted that the time of incubation of Ca and PPi ions was a critical parameter in determining the type of crystal formed. The biologic grade gelatin model studies that we conducted indicated that the formation of the two in vivo crystals was mediated by the formation of intermediate crystalline materials and the subsequent dissolution of those species. This formation/dissolution/reformation mechanism allows for a very localized ionic concentrating process to occur. In our model system, we measured the final Ca and PPi levels at all points of crystallization and could map the ionic concentration gradients and compare them to the crystal type formed with respect to the time of incubation. However, the crystal growth morphologies for t-CPPD and m-CPPD still did not match the morphologies observed in vivo.(ABSTRACT TRUNCATED AT 400 WORDS)
Rheumatic Disease Clinics of North America 09/1988; 14(2):321-40. · 3.02 Impact Factor
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ABSTRACT: Hydroxyapatite crystals in spheroid-shaped masses 1.9-15.6 micrometer in diameter were found in 12 of 13 synovial fluids obtained from the shoulder joints of 4 patients with rotator cuff tears and glenohumeral osteoarthritis. Two of 16 control joint fluids also showed these particles. Collagen types I, II and III were identified in the joint fluid pellets from 3 of the 4 patients, and fibers with typical collagen periodicity were also seen on transmission electronmicroscopy. Collagenase and neutral protease activities were found in fluids from 5 joints in 3 patients, whereas active collagenase was found in only 1 of 10 fluids from rheumatoid arthritis patients and in none of 3 fluids from patients with osteoarthritis. Neutral protease activities were present in several rheumatoid joint fluids. These findings are compatible with the hypothesis of an enzymatic release of hydroxyapatite crystals from the synovium and endocytosis by synovial macrophage-like cells with subsequent crystal-stimulated release of collagenase and neutral protease into the joint fluid, completing a pathogenetic cycle.
Arthritis & Rheumatism 04/1981; 24(3):474-83. · 7.87 Impact Factor
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ABSTRACT: Optimum coordinate sets have been obtained for ferrocytochrome c and the two symmetry-independent molecules of ferricytochrome c from tuna at 2.0 A resolution by making the best fit of models with standard bond lengths and angles to the experimental electron density maps (1977) J. Biol. Chem. 252, 759-785, as a preliminary to full refinement with 1.5 A data. Both the Diamond model-building programs and locally developed minicomputer routines were tried, with the latter preferred for economy and ease of operation, although both gave satisfactory results. Atomic coordinates are available on microfiche or from the Brookhaven Protein Data Bank. Using the two ferricytochrome molecules as a control, no differences between oxidized and reduced cytochrome molecules can be seen that are outside the probable limits of accuracy of the 2.0 A analysis. Rotation and subtractive difference map comparisons also show no conformation changes. If believable differences do appear in the course of the 1.5 A refinement now underway, these should be no more than minor breathing of main chain or adjustment of side chains.
Journal of Biological Chemistry 08/1977; 252(13):4619-36. · 4.77 Impact Factor
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ABSTRACT: The x-ray crystal structure analysis of tuna ferrocytochrome c has been extended from 2.45 to 2.0 A resolution. The overall folding is unchanged and is the same as has been reported for tuna ferricytochrome c (Swanson R., Trus, B.L., Mandel, N., Mandel, G., Kallai, O.B., and Dickerson, R.E. (1977) J. Biol. Chem. 252, 759-755). No significant structural differences are observed between oxidation states. Difference map studies using reoxidized crystals of ferrocytochrome c confirm the absence of a conformation change. A detailed analysis of hydrogen bonding shows the presence of six beta or 310 bends of type II with obligatory glycines in the 3rd residue position. This explains 6 of the 10 nearly invariant glycines in the molecule. Close packing contacts account for three more, and only the invariant glycine 1 remains a mystery.
Journal of Biological Chemistry 02/1977; 252(2):776-85. · 4.77 Impact Factor
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ABSTRACT: The crystal structure of oxidized cytochrome c from tuna hearts has been solved by x-ray diffraction to a resolution of 2.0 A, using four isomorphous heavy atom derivatives. The crystals, space group P43, have 2 independent cytochrome molecules in the asymmetric repeating unit. No significant difference is seen between these 2 molecules, aside from conformations of a few surface side chains. The molecular folding observed is essentially that reported for tuna ferrocytochrome c. In particular, the ring of phenylalanine 83 lies against the heme group and closes the heme crevice, and is not swung out into the surroundings as had been believed from the 2.8 A horse ferricytochrome c structure.
Journal of Biological Chemistry 02/1977; 252(2):759-75. · 4.77 Impact Factor
