Localized fibrous tumours of the pleura: 15 new cases and review of the literature.

OBJECTIVE: To present a series of localized fibrous tumours of the pleura (LFTP), to define the clinical and histopathological diagnostic criteria of this tumour, and to determine the optimal treatment and follow-up. METHODS: Review of the charts of the patients with the diagnosis of LFTP (formerly called benign fibrous mesothelioma), as well as of all the histological sections, including immunohistochemical stains. Review of the literature with special emphasis on the clinical and histological criteria of malignancy. RESULTS: During the last 30 years, we found 15 patients with a complete clinical chart and histological material, particularly paraffin blocks of the tumour. The mean age was 57 years (range 27-79). Eight patients were asymptomatic, and the remaining seven presented with non-specific symptoms. All but one had complete resection of the tumour, including partial lung resection in two and partial chest wall resection in three. The diagnosis was confirmed by histological review in 15 cases. Immunohistochemical stainings showed positivity for vimentin in all cases, for CD 34 in 80%, but were consistently negative for cytokeratins. Nine tumours were histologically classified as malignant. Among them, five recurred, two of which were responsible for death. One benign tumour recurred after 1 year, and was treated successfully by repeat resection and radiotherapy. Overall, 13 patients (86%) were alive with no evidence of disease between 10 months and 27 years after the first resection. CONCLUSIONS: LFTP is a rare tumour which has a benign clinical course in over 80% of the cases, and is asymptomatic in half the patients. The diagnosis is difficult to establish before operation. Treatment consists of complete resection including adjacent structures if necessary. The clinical behaviour of LFTP cannot be predicted on the basis of histological aspects only. If histologically malignant tumours are more prone to recurrence and poor outcome, broad-based and locally invasive tumours bear a higher risk of recurrence. Long term follow-up is therefore mandatory in all cases in order to perform early re-resection when recurrence occurs.

In situ introducer sheath dilatation for complex aortic access.

Aortic access problems due to diseased or small peripheral vessels are a major issue in endovascular aneurysm repair (EVAR). In the emergency setting, like aortic rupture after blunt trauma, or in patients with a hostile abdomen, a more proximal access to the aorta is not a pleasant perspective. We developed in situ introducer sheath dilatation as a bail-out technique for patients with difficult aortic access under various circumstances including EVAR, intra-aortic balloon pump insertion and cannulation for perfusion. The method described allows to increase the access vessel diameter by 50% (from 6 to 9 mm) or the luminal circumference from 18 to 27 F. We have used this technique in five patients without complication, very much in contrast to the traditionally practiced 'forced device insertion'.

Individual patient data systematic review and meta-analysis of optic nerve sheath diameter ultrasonography for detecting raised intracranial pressure: protocol of the ONSD research group.

BACKGROUND: The purpose of the optic nerve sheath diameter (ONSD) research group project is to establish an individual patient-level database from high quality studies of ONSD ultrasonography for the detection of raised intracranial pressure (ICP), and to perform a systematic review and an individual patient data meta-analysis (IPDMA), which will provide a cutoff value to help physicians making decisions and encourage further research. Previous meta-analyses were able to assess the diagnostic accuracy of ONSD ultrasonography in detecting raised ICP but failed to determine a precise cutoff value. Thus, the ONSD research group was founded to synthesize data from several recent studies on the subject and to provide evidence on the diagnostic accuracy of ONSD ultrasonography in detecting raised ICP. METHODS: This IPDMA will be conducted in different phases. First, we will systematically search for eligible studies. To be eligible, studies must have compared ONSD ultrasonography to invasive intracranial devices, the current reference standard for diagnosing raised ICP. Subsequently, we will assess the quality of studies included based on the QUADAS-2 tool, and then collect and validate individual patient data. The objectives of the primary analyses will be to assess the diagnostic accuracy of ONSD ultrasonography and to determine a precise cutoff value for detecting raised ICP. Secondly, we will construct a logistic regression model to assess whether patient and study characteristics influence diagnostic accuracy. DISCUSSION: We believe that this IPD MA will provide the most reliable basis for the assessment of diagnostic accuracy of ONSD ultrasonography for detecting raised ICP and to provide a cutoff value. We also hope that the creation of the ONSD research group will encourage further study. TRIAL REGISTRATION: PROSPERO registration number: CRD42012003072.

Control of thrombin signaling through PI3K is a mechanism underlying plasticity between hair follicle dermal sheath and papilla cells.

In hair follicles, dermal papilla (DP) and dermal sheath (DS) cells exhibit striking levels of plasticity, as each can regenerate both cell types. Here, we show that thrombin induces a phosphoinositide 3-kinase (PI3K)-Akt pathway-dependent acquisition of DS-like properties by DP cells in vitro, involving increased proliferation rate, acquisition of ;myofibroblastic' contractile properties and a decreased capacity to sustain growth and survival of keratinocytes. The thrombin inhibitor protease nexin 1 [PN-1, also known as SERPINE2) regulates all those effects in vitro. Accordingly, the PI3K-Akt pathway is constitutively activated and expression of myofibroblastic marker smooth-muscle actin is enhanced in vivo in hair follicle dermal cells from PN-1(-/-) mice. Furthermore, physiological PN-1 disappearance and upregulation of the thrombin receptor PAR-1 (also known as F2R) during follicular regression in wild-type mice also correlate with such changes in DP cell characteristics. Our results indicate that control of thrombin signaling interferes with hair follicle dermal cells plasticity to regulate their function.

[Doublon: 10.1007/s00428-009-0853-4] Soft tissue sarcomas with complex genomic profiles.

Soft tissue sarcomas (STS) with complex genomic profiles (50% of all STS) are predominantly composed of spindle cell/pleomorphic sarcomas, including leiomyosarcoma, myxofibrosarcoma, pleomorphic liposarcoma, pleomorphic rhabdomyosarcoma, malignant peripheral nerve sheath tumor, angiosarcoma, extraskeletal osteosarcoma, and spindle cell/pleomorphic unclassified sarcoma (previously called spindle cell/pleomorphic malignant fibrous histiocytoma). These neoplasms show, characteristically, gains and losses of numerous chromosomes or chromosome regions, as well as amplifications. Many of them share recurrent aberrations (e.g., gain of 5p13-p15) that seem to play a significant role in tumor progression and/or metastatic dissemination. In this paper, we review the cytogenetic, molecular genetic, and clinicopathologic characteristics of the most common STS displaying complex genomic profiles. Features of diagnostic or prognostic relevance will be discussed when needed.

Fibrous P.C. Concrete Overlay Research Green County, Iowa, December 1978

The Greene County, Iowa overlay project, completed in October 1973, was inspected on October 16 & 17, 1978 After five years of service The 33 fibrous concrete sections, four CRCP sections, two mesh reinforced and two plain concrete sections with doweled reinforcement were rated relative to each other on a scale of 0 t o 100. The rating was conducted by the original members of the Project Planning Committee, Iowa DOT, Iowa Counties, Federal Highway Administration, University of Illinois and industry representatives . In all , there were 23 representatives who rated this project . The 23 values were then averaged to provide a final rating number for each section. The highest panel rating (90) was assigned to the 5-inch thick , deformed barre in forced PCC sections ; an 86t o a 3-inch thick , 160 lbs. of fiber and 600 lbs . of cement on a partial bonded surface ; an 84 to the 4-inch CRC with elastic joints (bonded) and an 84 to a 4-inch mesh reinforce section. One of the major factors influencing performance appears t o be the thickness. In the fibrous concrete overlay, The greatest influences appears t o be the fiber content. Overlay Sections containing 160 1b/yd3 of Fiber are, in almost all cases , outperforming those c o n t a i n i n g 60 or 100. It is obvious at This time meth at the 3-inch thick fibrous concrete overlays are, in general, out performing the 2-inch thick sections. The performance of the fibrous concrete the overlay appears to be favorably influenced by: (1) The use of higher a spectra fiber (0.025 x 2.5 i n c h e s ) v e r s u s (0.010 x 0.022 x 1.0 inches) (2) The use of a lower cement c o n t e n t ( 600 versus 750 1b/yd3) However, The set less well defined and the improvements in overlay performance attributed to high aspect ratio fibers and low cement contents.

Intérêt de l'échographie du diamètre de l'enveloppe du nerf optique pour la détection non invasive de l'hypertension intracrânienne [Interest of optic nerve sheath diameter ultrasonography in dectecting non-invasively raised intracranial pressure].

Intracranial hypertension is an emergency suspected from clinical symptoms, imaging data and ophthalomologic signs. Intracranial hypertension is confirmed by invasive intracranial monitoring, which is the gold standard technique to measure intracranial pressure (ICP). Because of complications, hemorrhage or infection, non-invasive methods have been developed such as neuroimaging, transcranial Doppler sonography and optic nerve sheath diameter (ONSD) ultrasonography. We have reviewed ONSD technique that detects intracranial hypertension related volume variations of subarachnoid space along the retro bulbar segment of the optic nerve. Technique, indications and prospects are discussed.

A Fifteen Year Performance Summary of Fibrous PC Concrete Overlay Research in Greene County, Iowa, HR-165, 1989

The Greene County, Iowa, overlay project, completed in October 1973, was evaluated in October 1978, after five years in October 1983, after ten years and most recently in October 1988 after fifteen years of service. The 33 fibrous concrete sections, four CRCP sections, two mesh reinforced and two plain concrete sections with doweled reinforcement were rated relative to each other on a scale of 0 to 100. The rating was conducted by original members of the Project Planning Committee, Iowa DOT, Iowa County, Federal Highway Administration and industry representatives. In all, there were 23, 25 and 17 representatives who rated the project in 1978, 1983 and 1988 respectively. The 23, 25 or 17 values were then averaged to provide a final rating number for each section or variable. All experimental overlay sections had performed quite well in the period from five through 15 years, experiencing only limited additional deterioration.

Crack Survey for Fibrous P.C. Concrete Overlay Research in Greene County, Iowa, HR-165, 1979

The three miles of fibrous concrete resurfacing in Greene County, Iowa were placed in September and early October, 1973. It was recognized in advance that cracking and other performance characteristics of the fibrous concrete sections and of the control sections would be major factors in the evaluation of the project. A low level aerial survey was made of the old pavement. During construction of the resurfacing, the aerial survey was checked to insure that cracks in the old pavement were referenced to the 100 ft. station marks placed in the resurfacing. A final report for research project HR-165, based upon overall performance evaluation was published in December 1978.

Fibrous Concrete Resurfacing Greene County, Iowa, HR-165, 1976

The three miles of fibrous concrete resurfacing in Greene County, Iowa were placed in September and early October, 1973. It was recognized in advance that cracking and other performance characteristics of the fibrous concrete sections and of the control sections would be major factors in the evaluation of the project. A low level aerial survey was made of the old pavement. During construction of the resurfacing, the aerial survey was checked to insure that cracks in the old pavement were referenced to the 100 ft. station marks placed in the resurfacing. Crack surveys have been conducted on dates indicated below. Additional cracks found at each subsequent survey are shown in a color matching the date notation. April, 1974 November, 1974 October, 1975 October, 1976