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Orlando, FL, United States

Podberezin M.,Methodist Hospital | Wen J.,Methodist Hospital | Chang C.-C.,Florida Hospital
Archives of Pathology and Laboratory Medicine | Year: 2013

Context.-Cancer stem cells (CSCs) comprise a minor cell population in a tumor; however, they possess selfrenewal capacity and are responsible for tumor recurrence and the emerging issue of tumor resistance. Despite recent advances in the study of pathogenesis and mechanisms of CSC-mediated disease recurrence and multidrug resistance, many questions remain unanswered. Objectives.-To provide an overview of CSC theory and to describe major methods of CSC detection and isolation, with the emphasis on those techniques that are potentially relevant in clinical laboratory practice. Particular attention is given to CSC markers, such as cancer testis antigens, which could become promising targets in the development of immunotherapy in settings of minimal residual disease. Data Sources.-The review is based on analysis of peerreviewed literature cited in PubMed, as well as preliminary results of studies conducted in our laboratory. Conclusions.-Despite a lack of consensus in the scientific community on research methodology, CSCs have demonstrated significant potential as therapeutic targets in the treatment of cancer. Further research of CSC biology and markers will eventually lead to the development of novel therapeutic approaches for targeting these cells to treat resistant and recurrent tumors and minimal residual disease. Copyright © 2013 College of American Pathologists.

Bancroft L.W.,Florida Hospital
Skeletal Radiology | Year: 2011

Peer-reviewed abstracts presented at the 2010 Society of Skeletal Radiology (SSR) Annual Meeting were reviewed again following oral presentation. Topics representing new concepts, new or novel imaging techniques, and instructive case series involving the musculoskeletal system, felt to be of potential interest to investigators and practicing clinicians, have been highlighted in this compilation and analysis. © ISS 2010.

Peerschke E.I.B.,Sloan Kettering Cancer Center | Castellone D.D.,Roche Holding AG | Francis J.,Florida Hospital
American Journal of Clinical Pathology | Year: 2014

Objectives: To develop reference ranges for platelet aggregation using the Multiplate analyzer (Roche Diagnostics, Mannheim, Germany) in blood anticoagulated with sodium citrate (Na-citrate), lithium heparin (Li-heparin), or hirudin. Methods: The study was performed at three sites on consented, healthy adults (n = 193) not taking antiplatelet medication. Platelet aggregation was evaluated in response to adenosine-5'-diphosphate, arachidonic acid, collagen, thrombin receptor activating peptide, ristocetin, and adenosine-5'-diphosphate combined with prostaglandin E1. Precision testing was conducted using healthy donors and donors taking aspirin. Results: Whole-blood platelet aggregation showed anticoagulant-dependent differences in platelet responses to all agonists. Samples collected in Na-citrate demonstrated the lowest responses to all agonists. The highest responses were obtained using Li-heparin. Precision testing revealed high variability in platelet aggregation at lower agonist doses, regardless of anticoagulant. Highest platelet response variations occurred in response to arachidonic acid in blood anticoagulated with hirudin from participants taking aspirin. Conclusions: These data demonstrate the importance of establishing locally relevant reference ranges. © American Society for Clinical Pathology.

News Article | August 23, 2016
Site: www.rdmag.com

A South Florida boy has survived a rare brain-eating amoeba that kills most people, aided in part because a hard-to-get drug to fight the infection is made by a company based in Orlando where he was hospitalized, doctors said Tuesday. Sebastian DeLeon came to the hospital two weeks ago with sensitivity to light and a headache so severe the 16-year-old couldn't tolerate anyone touching him, doctors at Florida Hospital for Children said at a news conference. Hospital staffers had been trained to look for the amoeba, which often is contracted through the nose when swimming in freshwater lakes or rivers. The infection has a fatality rate of 97 percent and another boy died from it at the same hospital two years ago. The Centers for Disease Control and Prevention says only four out of 138 people have survived being infected with the amoeba in the past 50 years, including DeLeon, according to the hospital's doctors. "It is so rare that a lot of times we don't think of it and that's where a delay occurs in starting a treatment," said Dr. Dennis Hernandez, head of the hospital's emergency department. "It wasn't very clear-cut and I'm still shaking about the whole case." DeLeon, who had worked as a camp counselor in Broward County, was infected in South Florida. He began having a severe headache two weeks ago on the same day his family traveled to Orlando for a vacation. His parents took him to the emergency room at Florida Hospital almost a day and a half later when his headache worsened. Acting on a hunch, emergency room doctors ordered a spinal tap to test for meningitis, and lab scientist Sheila Black found the amoeba moving in the spinal fluid. Doctors lowered the teen's body temperature to 33 degrees, induced a coma, inserted a breathing tube and gave him a cocktail of drugs that help kill the amoeba. One of the drugs, miltefosine, isn't readily available at most hospitals. "When the family came to me, I had to tell them to say their goodbyes," said Dr. Humberto Liriano, who choked up as he described the case. "I had to tell them, 'Tell him everything you would want to tell your child because I don't know if he will wake up.'" Luck was on DeLeon's side since the manufacturer of miltefosine is based in Orlando, and a shipment got to the hospital quickly. "This infection can be rapidly fatal. Minutes count and having the drug rapidly at hand ... is crucial," said Dr. Federico Laham, a hospital pediatrician specializing in infectious diseases. Because the amoeba infection is so rare, the Centers for Disease Control and Prevention typically flies the drug miltefosine to the patient. But in DeLeon's case, a hospital pharmacist called the chief executive of the Orlando-based company that manufactures the drug and the CEO's son dropped it off at the hospital within minutes. The drug, which originally was used to treat breast cancer, isn't readily available. But the manufacturer, Profounda Inc., and the family of the 12-year-old boy who died from an amoeba infection at Florida Hospital two years ago, are pushing for the drug to be in hospitals, especially in the South where the amoeba thrives in warm weather. DeLeon is expected to recover with therapy. He is still at the hospital and needs a walker to get around, doctors said. "We are so thankful that God has given us this miracle through this medical team ... to have our son back and having him full of life," said Brunilda Gonzalez's DeLeon's mother. "He's a very energetic, adventurous, wonderful teen. We are so thankful for the gift of life."

Koenig S.,Hofstra North Shore Long Island Jewish Medical Center | Chandra S.,Columbia University | Alaverdian A.,Nassau University Medical Center | Dibello C.,Florida Hospital | And 2 more authors.
Chest | Year: 2014

Background: CT pulmonary angiography (CTPA) is considered the gold standard for the diagnosis of pulmonary embolism (PE) and is frequently performed in patients with cardiopulmonary complaints. However, indiscriminate use of CTPA results in significant exposure to ionizing radiation and contrast. We studied the accuracy of a bedside ultrasound protocol to predict the need for CTPA. Methods: This was an observational study performed by pulmonary/critical care physicians trained in critical care ultrasonography. Screening ultrasonography was performed when a CTPA was ordered to rule out PE. The ultrasound examination consisted of a limited ECG, thoracic ultrasonography, and lower extremity deep venous compression study. We predicted that CTPA would not be needed if either DVT was found or clear evidence of an alternative diagnosis was established. CTPA parenchymal and pleural findings, and, when available, formal DVT and ECG results, were compared with our screening ultrasound findings. Results: Of 96 subjects who underwent CTPA, 12 subjects (12.5%) were positive for PE. All 96 subjects had an ultrasound study; two subjects (2.1%) were positive for lower extremity DVT, and 54 subjects (56.2%) had an alternative diagnosis suggested by ultrasonography, such as alveolar consolidation consistent with pneumonia or pulmonary edema, which correlated with CTPA findings. In no patient did the CTPA add an additional diagnosis over the screening ultrasound study. Conclusions: We conclude that ultrasound examination indicated that CTPA was not needed in 56 of 96 patients (58.3%). A screening, point-of-care ultrasonography protocol may predict the need for CTPA. Furthermore, an alternative diagnosis can be established that correlates with CTPA. This study needs further verification, but it offers a possible approach to reduce the cost and radiation exposure that is associated with CTPA. © 2014 American College of Chest Physicians.

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