Carcinoid tumors of the appendix

OBJECTIVE: A retrospective study of 41 patients with histologically confirmed diagnosis of appendix carcinoid tumors was undertaken by reviewing the surgical records at Massachusetts General Hospital. METHODS: There were 8 male and 33 female patients (mean age 32 years). Twenty-two patients (54%) presented with signs and symptoms suggestive of acute appendicitis. In 19 patients (46%) the lesions were discovered incidentally. The tumors were located in 32 patients at the tip, in 6 patients in the middle third, and in 3 patients at the base of the appendix. The tumor was less than 1 cm in diameter in 32 patients, between 1 and 2 cm in 7 patients, and was bigger than 2 cm in 2 patients. In 29 patients, the depth of tumor penetration was confined to the submucosa or to the muscle layers of the appendix, and in 8 patients the serosa was involved. In 4 patients, evidence of tumor extension into the meso-appendicular fat was present, including one patient with a tumor bigger than 2 cm and local lymph-node metastases. Forty patients underwent appendectomy alone. One patient with a tumor size bigger than 2 cm in diameter with positive lymph nodes in the mesoappendix underwent secondary right hemicolectomy. Complete follow-up was achieved in 35 patients, and all patients remained free of tumor recurrence. CONCLUSIONS: The authors conclude that appendiceal carcinoids are rare and most often are asymptomatic. Tumors of less than 1 cm are adequately managed by appendectomy alone. The appropriate treatment for tumors of 1 to 2 cm continues to be controversial. Right hemicolectomy is recommended for all tumors larger than 2 cm, whereas preference for an aggressive approach should be given in young patients.     

Clinodactyly following electric burns. Observations on two cases

The authors report two cases of distal clinodactyly secondary to electrical burns. It is hypothesized that the etiology is a unilateral ischemic necrosis of the epiphysis. Depending on the stage in which the deformity is discovered, treatment is preventive or palliative.     

Invagination of the vermiform appendix. A report of two cases associated with endometriosis

Two cases of invagination of the Vermiform appendix associated with endometriosis are presented. Classification, incidence, etiology, symptomatology, diagnosis and treatment are discussed. The literature is reviewed in brief, and it is concluded that the possibility of invagination of the Vermiform appendix should be considered in obsure abdominal cases with recurrent right lower quadrant pain.     

Carcinoid tumour complicating inflammatory bowel disease. A study of two cases with review of the literature

Two cases of carcinoid tumour complicating inflammatory bowel disease (IBD) are presented. Both tumours were located in the appendiceal tip. The first case occurred in a man with Crohn's disease (CD), and the second one in a woman suffering from ulcerative colitis (UC). Histochemical and immunohistochemical studies were not allowed on case 1 because the tumour was not still present on serial sections of the appendix. On case 2, tumour cells were not reactive with Grimelius and Masson-Fontana stainings, but were strongly stained with anti-keratin and anti-chromogranin monoclonal antibodies (MAb), and faintly expressed neuron specific enolase (NSE), and Leu-7. Both cases occurred in inflammatory or damaged mucosa which exhibited Paneth cell metaplasia and hyperplasia and areas indefinite for dysplasia. Along with these lesions, hyperplasia of enteroendocrine cells was pointed out in the neighbouring appendiceal and colonic mucosa by means of anti-chromogranin MAb. These data suggest that the association of carcinoid tumour with IBD, albeit rare, is not coincidental and is the result of hyperplastic and dysplastic troubles that may involve enteroendocrine cells as well as such other derivatives of digestive stem cells as columnar cells, goblet cells and Paneth cells.     

Carcinoid tumor of the gallbladder

The carcinoid tumor is a relatively rare type of endocrine tumor, which arises mainly in the gastrointestinal tract. Primary gallbladder and biliary duct system carcinoids comprise less than 1% of all carcinoid tumors arising from any tissue or organ in the body. We describe a case of carcinoid tumor of the gallbladder in a 39-year-old man. There have been only 32 cases described in the literature.     

Carcinoid tumours of the thymus

Analysis by isoelectric focusing of serum alpha 1-antitrypsin phenotype of 167 consecutive cases from an occupational health outpatient clinic, from university hospital departments and from private practitioners showed an excessive presence of rare gene alleles S, Z, I and anodal variants compared to their frequencies in blood donors from Lausanne or in the general Swiss population. It seems that analysis has been well grounded in most cases and helps to establish diagnosis in many respiratory diseases, in unexplained liver cirrhosis and even in aortic rupture.     

Carcinoid tumors of the lung

Resection of typical bronchial carcinoid was carried out in 203 patients. The average age was 48 years, and the sex distribution was approximately equal. Bronchoscopy was the most definitive diagnostic procedure, even though 15% of the tumors were located in the segmental bronchus or beyond. Conservative resection including local removal of the lesion was the treatment of choice, but distal suppuration and location of the tumor necessitated pneumonectomy in 54 (27%) of the patients. The incidence of metastasis was 5% (11 patients), and the overall hospital mortality was 3%. Of patients who qualified for follow-up, 94% survived 5 years, and of those who were asymptomatic preoperatively, 98% survived 5 years. The 10- and 25-year survival rates for the group as a whole were 87 and 66%, respectively.     

Atresia of the appendix

A 4-day-old black male underwent laparotomy for intestinal obstruction. At surgery, multiple jejunal atresias (type IV) of the jejunum were detected. As an incidental finding, atresia of the appendix was also present. The jejunal atresia was repaired, and resection of the tip of the cecal pole and atretic appendix was performed. Gross and histological examination confirmed the presence of a type IV atresia of the jejunum and a cordlike (type II) atresia of the appendix with inflammatory changes in the tip of the appendix. The boy made an uneventful recovery. Examination of all organ systems did not show any associated findings, and the family history was unremarkable. To our best knowledge, this case represents the first case of atresia of the appendix described in the literature.     

Observations on the retirement of professional psychologists.

If you are interested in eventual retirement, this article discusses some issues that you may wish to consider. For example, a variety of ethical, legal, professional, business, clinical, and personal considerations are critical when a psychologist decides to retire and close a practice. When these diverse considerations are approached sensitively and are well resolved, the best interests of clients are emphasized, and optimally, they will cope more adequately with their psychologist's retirement. Managing these considerations effectively will also enhance the psychologist's move into retirement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Observations on the Zirconium Hydride Precipitation and Distribution in Zircaloy-4

Hydride precipitation and distribution in hot-rolled and annealed Zircaloy-4 plate samples artificially induced by gaseous hydrogen charging were studied primarily by neutron tomography, scanning electron microscopy (SEM), and SEM-based electron backscattered diffraction techniques. The precipitated hydride platelet (δ-ZrH_1.66) at a hydrogen pressure of 20 atm was found following the {111} _δ-ZrH1.66//(0001) _α-Zr with the surrounding α-Zr matrix. The microstructural characterization indicated that hydrides with a relatively uniform distribution were precipitated on the rolling-transverse section of the plate, whereas, on the normal-transverse section, a hydride concentration gradient was present with a dense hydride layer near the surface. Further, the neutron tomography investigations clearly identified the nonuniform spatial distribution of hydrides. Thin hydride layers preferentially formed on the sample surface, and the concentrated hydrides precipitating at the edges/corner of the sample were observed. The causes for the localized hydride accumulation were also discussed.     

Aspergillosis of the sphenoid sinus. Apropos of 4 cases

Aspergillosis of the sphenoid sinus is a rare entity. The authors report four cases of non invasive aspergillosis sinusitis, three isolated cases and one with nasal polyps. All cases were treated by functional endoscopic surgery. Good results were noted with a mean follow-up of 18 months. Frequency, clinical features, treatment, and etiopathogenesis of sphenoidal aspergillosis are discussed.     

Observations on Research Training.

This comment suggests a plan for implementing the goals of graduate training programs. The principal feature of the plan is the actual participation of the student in research every semester. The required amount of time could vary from approximately three semester hours in the student's first year to approximately nine semester hours in his last year. Benefits of the plan are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Carcinoid of the major duodenal papilla

As demonstrated on the basis of clinico-epidemiological diagnostics, large epidemics of viral hepatitis (VH), earlier considered to be the epidemics of VHA, were in reality epidemics of VHE. Such epidemics originated due to the influence of the water factor and were called forth by the drying-up of rivers in Central Asia, which played an important role in their appearance. In combination with unusually high average monthly temperatures, especially in spring and summer, this is an important sign for the prognostication of new water epidemics of VHE.     

Observations on the Politics of Multidisciplinary Health Research.

In multidisciplinary health research, psychologists work as equals with other professionals to investigate health issues from a broad perspective. However, the domain of such research--the health care system--is frequently outside the psychologist's habitual territory. This article examines the role of psychologists in this line of work and the politics relating to their success. Discussion focuses on how the psychologist presents him/herself as being able to improve and add to the research, the importance of personal and professional credibility, professional language, and other practical concerns. Although multidisciplinary health research is becoming a more established activity for psychologists, few precedents currently exist for defining the psychologist's position. So every study adds not only to the body of knowledge of health but also to the character and identity of psychology as a discipline. Attention to the interpersonal and political aspects of health research is critical to the development of the field. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adenocarcinoma of the cecal appendix

The authors report one rare case of primary adenocarcinoma of the vermiform appendix. The patient, an 83 year old female, presented with a non-pathognomonic symptomatology; diagnosis was made postoperatively. Surgery consisted of appendicectomy. The patient, due to her poor general condition, died three days after surgery for cardiocirculatory complications. In the light of the very rare case published in the literature, some diagnostic, anatomic-clinical, therapeutic and prognostic aspects of this rare tumor are discussed.