Epithelioid sarcoma: a clinicopathologic review of 55 cases

OBJECTIVE: To identify any clinical and pathologic features of treatment modalities that are predictive of outcome in patients with epithelioid sarcoma, a rare slow-growing soft tissue tumor most commonly occurring in the distal extremities of young adults. DESIGN: We reviewed the institutional files for cases of epithelioid sarcoma for the period 1956 to 1991 and analyzed the effect of various factors on survival. MATERIAL AND METHODS: Fifty-five cases of epithelioid sarcoma were found, and the relevant clinical, pathologic, treatment, follow-up, and outcome features were assessed. RESULTS: All tumors were treated initially by operative resection. The recurrence rate progressively decreased with increasing aggressiveness of the initial operation; however, no difference was noted in metastatic rate. Overall, the recurrence rate was 38% and the metastatic rate was 47%. At the end of a mean follow-up of 102 months, 69% of patients had no evidence of disease, 27% had died of the disease, and 4% were alive with disease. Increasing tumor size, necrosis of more than 30%, and vascular invasion correlated significantly with a worse prognosis. CONCLUSION: Epithelioid sarcoma should be considered a malignant neoplasm with a significant potential for aggressive behavior, and close follow-up of affected patients should be maintained for many years. Initial treatment should be aggressive in an attempt to prevent recurrence.     

An improved error estimate for reduced-order models ofdiscrete-time systems

The authors derive, under weaker conditions, a discrete-time counterpart of K. Glover's (1984) error estimate for reduced-order models. Following the same lines, a simple proof of Glover's result for continuous-time systems can be given     

A strategy for integrating product conceptualization and bid preparation

Collaboration with other members of the supply chain is one means by which small and medium sized enterprises (SMEs) can compete in today’s global business environment. Thus, early stages of the new product development process involve both technical activities, e.g., product platform definition, and commercial activities, e.g., bidding for contracts. This paper introduces an integrated collaborative bidding and design system (CBDS) to help SMEs coordinate the two aspects. General sorting was employed for initial requirements acquisition and platform definition; while a self-organizing map (SOM) neural network was combined with a concurrent cost-schedule estimation strategy for refinement of design options and bid evaluation/preparation. A case study on cellular phone design was then applied for illustrating the proposed prototype system.     

Longitudinal quantum beam tomography

Abstract

We propose an experiment to determine the density operator for the longitudinal quantum state of an atomic beam. The method is based on tomographic reconstruction of the Wigner function via a set of measured probability distributions for the phase-space rotated position operator. The time evolution of the Wigner function in free space effectively performs the required phase-space rotation. We propose a state-selective time-dependent technique for measuring longitudinal probability distributions.     

Thiopurine methyltransferase genotype predicts therapy-limiting severe toxicity from azathioprine

BACKGROUND: Substantial hematologic toxicity limits the use of azathioprine. OBJECTIVE: To evaluate 1) polymorphic inactivation of azathioprine by thiopurine methyltransferase and 2) clinical toxicity. DESIGN: Prospective cohort study. SETTING: Two rheumatology units. PATIENTS: 67 patients for whom azathioprine was prescribed as second-line therapy for rheumatic disease. MEASUREMENTS: Polymerase chain reaction-based assays were used to detect mutations in thiopurine methyltransferase. The primary end point was discontinuation of azathioprine therapy because of toxicity. RESULTS: Six of 67 patients (9%) were heterozygous for mutant thiopurine methyltransferase alleles. Five of the 6 patients discontinued therapy within 1 month of starting treatment because of low leukocyte counts. The sixth patient did not adhere to treatment. Patients with wild-type thiopurine methyltransferase alleles received therapy longer than did patients with mutant alleles (median duration of therapy, 39 weeks [range, 6 to 180 weeks] and 2 weeks [range, 2 to 4 weeks], respectively; P = 0.018). CONCLUSION: Analysis of thiopurine methyltransferase genotype is a quick way to identify patients at risk for acute toxicity from azathioprine.     

Visual size processing in spatial neglect

Evidence from the use of the landmark task and from two size-matching tasks shows that many patients with left-sided neglect systematically under-perceive visual extent in leftward parts of space. This perceptual distortion of size serves to explain the occurrence of rightward line-bisection errors in most neglect patients. One possibility is that attentional biases of a chronic nature might underlie these perceptual changes seen in neglect patients. But contrary to this idea, we have found that attentional cueing in the landmark task causes changes in neglect patients exactly opposite to those seen in healthy subjects. The distortions of size perception seen in neglect could instead be caused by a high-level alteration of visual processing rather than by an attentional bias. In order to explore which visual stream of cortical processing might be compromised in such a disorder, we have begun to examine neglect patients on visuomotor as well as perceptual tasks. We have found clear evidence in one patient for intact grip scaling for object size in the neglected half of space, despite gross perceptual underestimations of the same objects. This result suggests that neglect can occur without major disruption of the dorsal stream, and may result instead from damage to a cortical system whose predominant visual input comes from the ventral stream.     

Rectal trauma: management based on anatomic distinctions

Principles of rectal wound management, including routine diversion, injury repair, presacral drainage and distal washout, evolved from World War II and the Vietnam conflict and have been questioned in recent years. We believe significant confusion arises because of imprecise definition of injury location relative to retroperitoneal involvement. Our 5-year experience with penetrating rectal injuries at a Level I trauma center was analyzed. Injuries to the anterior and lateral surfaces of the upper two-thirds of the rectum were classified as intraperitoneal (IP, serosalized), and those of the posterior surface extraperitoneal (EP, no serosa); injuries to the lower one-third were EP. A total of 58 injuries were managed (92% gunshot wounds). Of these, 16 were IP, and 42 had some EP component. Ten patients underwent repair without diversion (6 IP, 4 EP); there were no leaks. Ten septic complications occurred in the remaining population: 2 necrotizing fasciitis, 5 abdominal abscess, and 3 presacral infections (PIs) (2 presacral abscesses and 1 wound tract infection). PI is the only complication that can be specifically associated with EP rectal injuries relative to management; as associated injury confounds interpretation of the other complications. The operative management in the 38 patients with diverted EP wounds with respect to presacral infection (PI) demonstrated the following: repair injury (n = 10), 0 PI versus no repair (n = 28), 3 PI (P = 0.55); washout (n = 33), 2 PI versus no washout (n = 5), 1 PI (P = 0.35); presacral drain (n = 30), 1 PI versus no drain (n = 8), 2 PI (P = 0.11). We conclude that most IP injuries can be managed with primary repair. EP wounds to the upper two-thirds of the rectum should usually be repaired. EP wounds to the lower one-third, which are explored and repaired, do not require drainage. EP wounds that are not explored should be managed with presacral drainage to minimize the incidence of presacral abscess.     

Apolipoprotein A-I(Zavalla) (Leu159-->Pro): HDL cholesterol deficiency in a kindred associated with premature coronary artery disease

We investigated the molecular defect causing high density lipoprotein cholesterol (HDL-C) deficiency in a male proband and his family members. Amplification and sequencing of genomic DNA disclosed a novel base-pair substitution at residue 159 in the apolipoprotein (apo) A-I gene. This substitution resulted in the loss of an AviII restriction site and a predicted substitution of leucine with proline at residue 159. Restriction enzyme analysis demonstrated absence of the AviII site in 19 of 40 biological family members. Compared with familial controls, subjects with the apoA-I(Zavalla) variant had reduced HDL-C (1.16 versus 0.27 mmol/L, P<0.0001), apoA-I (38.7 versus 124.4 mg/dL, P<0.0001), and apoA-II (14.3 versus 19.0 mg/dL, P<0.0001) levels. Two subjects who have developed coronary artery disease to date possess additional cardiovascular risk factors. Other heterozygotes for apoA-I(Zavalla) are presently without symptomatic coronary artery disease. This study identifies a monogenic cause of hypoalphalipoproteinemia, with the single base-pair substitution having a dominant effect on the low HDL-C phenotype. In addition, it extends recent observations that HDL-C deficiency states may be more prone to the development of premature coronary artery disease when accompanied by additional cardiovascular risk factors.