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Papp G.,Semmelweis University | Changchien Y.-C.,Semmelweis University | Peterfia B.,Semmelweis University | Pecsenka L.,The Surgical Center | And 5 more authors.
Modern Pathology | Year: 2013

About 10% of epithelioid sarcomas have biallelic mutation of the SMARCB1 (SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily b, member 1) gene resulting in a lack of this nuclear protein. It has been suggested that SMARCB1 may be silenced by epigenetic changes in the remaining 90% of tumors. Thus, we hypothesized that the promoter of SMARCB1 is hypermethylated. We also examined SMARCB1 mRNA level to determine if a post-translational change was possible. Thirty-six cases of epithelioid sarcomas were studied. Immunohistochemistry and mutation analysis of the SMARCB1 gene were performed to select appropriate cases. Methylation status was assessed by methylation-specific PCR. Laser capture microdissection of tumor cells followed by real-time PCR was applied to examine the expression of SMARCB1 mRNA. Of 36 epithelioid sarcomas, 31 (86%) displayed a lack of SMARCB1 nuclear protein. In all, 4 (13%) of 31 SMARCB1-negative cases harbored biallelic deletion while 9 (33%) cases showed single-allelic deletion. One (4%) frameshift deletion of exon 3 and one point mutation of exon 7 were also found. In 16 (59%) cases, both alleles were intact. Altogether, 25/31 (81%) SMARCB1-negative cases had at least one intact allele. None of these cases demonstrated promoter hypermethylation. Low levels of SMARCB1 mRNA were found in all cases with tumor tissue extracted RNA (because of the minimal normal cell contamination) but no mRNA could be detected in laser dissected cases (containing only tumor cells). Enhancer of zeste homolog 2 (EZH2) overexpression was not characteristic of epithelioid sarcoma. Thus, loss of SMARCB1 expression in epithelioid sarcoma is caused neither by DNA hypermethylation nor by post-translational modifications. Most likely it is the microRNA destruction of SMARCB1 mRNA but further investigations are needed to elucidate this issue. © 2013 USCAP, Inc. All rights reserved.


Passman M.A.,University of Alabama at Birmingham | McLafferty R.B.,University of Illinois at Springfield | Nagre S.B.,University of Alabama at Birmingham | Iafrati M.D.,Tufts University | And 6 more authors.
Journal of Vascular Surgery | Year: 2011

Background: Several standard venous assessment tools have been used as independent determinants of venous disease severity, but correlation between these instruments as a global venous screening tool has not been tested. The scope of this study is to assess the validity of Venous Clinical Severity Scoring (VCSS) and its integration with other venous assessment tools as a global venous screening instrument. Methods: The American Venous Forum (AVF), National Venous Screening Program (NVSP) data registry from 2007 to 2009 was queried for participants with complete datasets, including CEAP clinical staging, VCSS, modified Chronic Venous Insufficiency Quality of Life (CIVIQ) assessment, and venous ultrasound results. Statistical correlation trends were analyzed using Spearman's rank coefficient as related to VCSS. Results: Five thousand eight hundred fourteen limbs in 2,907 participants were screened and included CEAP clinical stage C0: 26%; C1: 33%; C2: 24%; C3: 9%; C4: 7%; C5: 0.5%; C6: 0.2% (mean, 1.41 ± 1.22). VCSS mean score distribution (range, 0-3) for the entire cohort included: pain 1.01 ± 0.80, varicose veins 0.61 ± 0.84, edema 0.61 ± 0.81, pigmentation 0.15 ± 0.47, inflammation 0.07 ± 0.33, induration 0.04 ± 0.27, ulcer number 0.004 ± 0.081, ulcer size 0.007 ± 0.112, ulcer duration 0.007 ± 0.134, and compression 0.30 ± 0.81. Overall correlation between CEAP and VCSS was moderately strong (r s = 0.49; P <.0001), with highest correlation for attributes reflecting more advanced disease, including varicose vein (r s = 0.51; P <.0001), pigmentation (r s = 0.39; P <.0001), inflammation (r s = 0.28; P <.0001), induration (r s = 0.22; P <.0001), and edema (r s = 0.21; P <.0001). Based on the modified CIVIQ assessment, overall mean score for each general category included: Quality of Life (QoL)-Pain 6.04 ± 3.12 (range, 3-15), QoL-Functional 9.90 ± 5.32 (range, 5-25), and QoL-Social 5.41 ± 3.09 (range, 3-15). Overall correlation between CIVIQ and VCSS was moderately strong (r s = 0.43; P <.0001), with the highest correlation noted for pain (r s = 0.55; P <.0001) and edema (r s = 0.30; P <.0001). Based on screening venous ultrasound results, 38.1% of limbs had reflux and 1.5% obstruction in the femoral, saphenous, or popliteal vein segments. Correlation between overall venous ultrasound findings (reflux + obstruction) and VCSS was slightly positive (r s = 0.23; P <.0001) but was highest for varicose vein (r s = 0.32; P <.0001) and showed no correlation to swelling (r s = 0.06; P <.0001) and pain (r s = 0.003; P =.7947). Conclusions: While there is correlation between VCSS, CEAP, modified CIVIQ, and venous ultrasound findings, subgroup analysis indicates that this correlation is driven by different components of VCSS compared with the other venous assessment tools. This observation may reflect that VCSS has more global application in determining overall severity of venous disease, while at the same time highlighting the strengths of the other venous assessment tools. © 2011 Society for Vascular Surgery.


Chouhan J.D.,Scott and White Memorial Hospital and Clinic | Chouhan J.D.,University of Texas at Austin | Herrington J.D.,Scott and White Memorial Hospital and Clinic | Herrington J.D.,University of Texas at Austin | Herrington J.D.,Texas A&M University
Journal of Oncology Pharmacy Practice | Year: 2011

Background: The administration of docetaxel requires the use of dexamethasone for the prevention of hypersensitivity reactions (HSRs) and fluid retention reactions (FRRs). The manufacturer recommends dexamethasone for 3 days starting the day before docetaxel. This regimen has the potential for nonadherence so the utility of a single dexamethasone dose would be welcomed. Objective: To ascertain the incidence of HSRs and FRRs after receiving a single dose of intravenous dexamethasone before docetaxel administration. Design: Retrospective chart review. Setting: Data set from an oncology clinic affiliated with a large, tertiary, academic, teaching hospital. Patients: Ninety patients (median age 59 years, range 40-92 years) with cancer (primarily breast cancer, nonsmall cell lung cancer and head/neck cancer) who received docetaxel. Measurements and Results: Patients with heart failure, renal failure, chronic edema, current steroid use and/or prostate cancer were excluded from the study. Seven patients (7.8%) experienced a HSR requiring a treatment intervention (fluid bolus, oxygen, steroid, and/or diphenhydramine). Eleven patients (12.2%) had documented fluid retention. The mean docetaxel dose at the onset of fluid retention was 247.2 ± 134.5 mg/m 2. Limitations: This single center evaluation with a small sample size had the potential for incomplete collection of the adverse events from the medical records due its retrospective nature. Conclusion: Hypersensitivity reactions and FRRs occurred in 7.8% and 12.2% of patients, respectively. This is lower than the rates reported by the manufacturer with the oral premedication regimen. © The Author(s) 2010.


Chaput C.D.,Scott and White Memorial Hospital and Clinic | Torres E.,Texas A&M University | Davis M.,Scott and White Memorial Hospital and Clinic | Song J.,Scott and White Memorial Hospital and Clinic | Rahm M.,Scott and White Memorial Hospital and Clinic
Journal of Trauma - Injury, Infection and Critical Care | Year: 2011

Background: Case series suggest that atlanto-occipital dissociation (AOD) is a potentially survivable injury. Intuitively, a significant neurologic injury, a high degree of initial distraction, and more severe associated injuries would decrease the likelihood of survival. However, this has never been demonstrated for this injury pattern in a statistically meaningful way. The purpose of this study was to assess the relationship of atlanto-occipital distraction, presence of a complete neurologic injury, and Injury Severity Score (ISS) to the rate of survival in AOD. Methods: One thousand one hundred seventy-four patients from 2005 to 2009 comprehensive trauma database were retrospectively reviewed. Fourteen patients diagnosed with AOD were included in the study. Outcome measures assessed included survival, neurologic status, and ISS. The basion-dens interval (BDI) was measured on the computed tomography scan. Fisher's exact test and Wilcoxon's test were used to evaluate possible associations. Results: Six patients died with complete, high cervical, spinal cord injuries. Follow-up for survivors ranged from 6 months to 2 years. Mortality was associated with the presence of complete neurologic deficit (p = 0.0047), a high basion-dens interval (>16 mm, p = 0.015), and a high ISS (p = 0.0373). Conclusions: AOD is a potentially survivable injury; however, there may be identifiable subsets of patients where the injury is so severe that treatment is unlikely to change the outcome. This is the first study to show that the ISS and the presence of a complete neurologic injury correlate with nonsurvivability of this devastating injury. A larger case series would help to generalize the results, given the small sample size. Copyright © 2011 by Lippincott Williams & Wilkins.


Kaur P.,Scott and White Memorial Hospital and Clinic | Kaur P.,Texas A&M University | Nagaraja G.M.,Scott and White Memorial Hospital and Clinic | Nagaraja G.M.,Texas A&M University | Asea A.,Scott and White Memorial Hospital and Clinic
Methods in Molecular Biology | Year: 2011

Elevated heat shock protein 27 (Hsp27) expression has been found in a number of tumors, including breast, prostate, gastric, uterine, ovarian, head and neck, and tumor arising from the nervous system and urinary system, and determined to be a predictor of poor clinical outcome. Although the mechanism of action of Hsp27 has been well documented, there are currently no available inhibitors of Hsp27 in clinical trials. RNA interference (RNAi) has the potential to offer more specificity and flexibility than traditional drugs to silence gene expression. Not surprisingly, RNAi has become a major focus for biotechnology and pharmaceutical companies, which are now in the early stages of developing RNAi therapeutics, mostly based on short interfering RNA (siRNAs), to target viral infection, cancer, hypercholesterolemia, cardiovascular disease, macular degeneration, and neurodegenerative diseases. However, the critical issues associated with RNAi as a therapeutic are delivery, specificity, and stability of the RNAi reagents. To date, the delivery is currently considered the biggest hurdle, as the introduction of siRNAs systemically into body fluids can result in their degradation, off-target effects, and immune detection. In this chapter, we discuss a method of combined lentiviral and RNAi-based technology for the delivery and permanent silencing of the hsp25 gene. © 2011 Springer Science+Business Media, LLC.


Chisholm C.,Scott and White Memorial Hospital and Clinic | Chisholm C.,Texas A&M University | Greene J.F.,Scott and White Memorial Hospital and Clinic | Greene J.F.,Texas A&M University
American Journal of Dermatopathology | Year: 2010

Nodular mucinosis of the breast is an extraordinarily rare lesion that occurs in patients who do not have Carney syndrome. Typically, the affected patients are young women with no medical history and a nodule under 1 nipple. Histopathologic examination has, until now, shown a multinodular myxoid lesion containing scattered capillaries and histiocytes but void of epithelial components. We present the case of a 72-year-old woman with a history of mucinous carcinoma of the breast who now presents with a painful subareolar nodule of the same breast. Biopsy and histological examination confirmed nodular mucinosis of the breast. Copyright © 2010 by Lippincott Williams & Wilkins.


Papaconstantinou H.T.,Texas A&M University | Papaconstantinou H.T.,Scott and White Memorial Hospital and Clinic | Sharp N.,Texas A&M University | Thomas J.S.,Texas A&M University
Journal of the American College of Surgeons | Year: 2011

Background: Single-incision laparoscopic (SIL) colectomy is an advance in minimally invasive colorectal surgical techniques. Feasibility and safety of SIL colectomy has been reported; however, benefits and outcomes are not well-defined. The purpose of this study was to compare outcomes of SIL right colectomy with multiport laparoscopic (LAP) and hand-assisted laparoscopic (HAL) techniques. Methods: SIL right colectomy cases performed between August 2009 and April 2010 were case-matched for age, sex, body mass index, American Society of Anesthesiologists score, previous abdominal surgery, and pathology to an equivalent number of LAP and HAL right colectomy cases. Data analyzed included operative time, procedure conversion, incision length, length of hospital stay, 30-day hospital readmission, surgical site infection and maximum postoperative pain score. Results: Twenty-nine patients were analyzed in each of 3 groups (SIL, LAP, and HAL). The mean age (p = 0.96), body mass index (p = 0.48), American Society of Anesthesiologists score (p = 0.74), and rate of previous abdominal operation (p = 0.95) were similar, and sex and pathology were identical among groups. Operative time and conversion rates were similar. The incision length for SIL (4.5 cm) and LAP (5.1 cm) groups was similar, and both were significantly shorter than HAL group (7.2 cm; p < 0.001). Length of hospital stay was 3.4 days for the SIL group and was more than 1-day shorter than LAP and HAL groups (p < 0.05). Postoperative surgical site infection and hospital readmission were similar among groups. Maximum pain score on postoperative days 1 and 2 was significantly lower in SIL group (p < 0.05). Conclusions: SIL right colectomy can improve patient recovery through a decrease in early postoperative pain and shorter length of hospital stay when compared with established laparoscopic techniques. © 2011 American College of Surgeons.


Seval D.L.,Texas A&M University | Buckley T.,Texas A&M University | Kuehl T.J.,Texas A&M University | Kuehl T.J.,Scott and White Memorial Hospital and Clinic | Sulak P.J.,Texas A&M University
Contraception | Year: 2011

Background: The survey was conducted to assess attitudes and patterns of health care providers (HCPs) prescribing extended regimen oral contraceptives (OCs). Study Design: A prospective, anonymous, written survey that assessed attitudes and prescribed preferences of extended-cycle OCs was distributed at six educational conferences. Results: An estimated 90% of the conference attendees participated in the survey. Of the 799 HCPs surveyed, 92% have recommended extended-cycle regimens with ob/gyn practitioners most likely to recommend their use (p<.05). The most commonly prescribed extended regimen remains an 84-day active pill cycle followed by a 7-day hormone-free interval (49%). The majority of HCPs (73.5%) continue to prescribe OCs which induce monthly withdrawal bleeds as their most common regimen. Conclusion: While HCPs appear to be recommending extended OC regimens more often, monthly cyclic regimens are the most commonly prescribed. © 2011 Elsevier Inc. All rights reserved.


Harmon L.,Scott and White Memorial Hospital and Clinic | Boccalandro F.,Odessa Heart Institute | Boccalandro F.,Texas Tech University Health Sciences Center | Boccalandro F.,Permian Research Foundation
Journal of Clinical Ultrasound | Year: 2014

Background: To evaluate the correlation and agreement of the carotid artery landmarks necessary for carotid artery stenting obtained by B-mode ultrasonography (BMU), and by quantitative angiography (QCA) in patients with severe carotid artery stenosis. Methods: In 75 patients undergoing carotid artery stenting, the distal common (CCA), proximal internal (ICA) carotid artery diameter, and lesion length were measured preoperatively by BMU, and intraoperatively by QCA. Results: In 96% of the subjects, BMU imaging was adequate for interpretation. BMU and QCA Pearson correlation and Lin concordance coefficients were 0.75 (p<0.001) and 0.959 (95% CI: 0.930 - 0.996), respectively, for CCA diameter, 0.88 (p<0.001) and 0.954 (95% CI: 0.928-0.983), respectively, for ICA diameter, and 0.62 (p<0.001) and 0.734 (95% CI: 0.719-0.760), respectively, for lesion length, with a 0.765 bias correction factor and a wider data scatter by Bland Altman plots showing shorter lesion length by BMU than by QCA. Conclusions: In patients with carotid artery stenosis, BMU can provide reliable distal CCA and proximal ICA diameters in comparison with QCA, whereas lesion length measured by BMU has an acceptable correlation, but a poor agreement with QCA. © 2014 Wiley Periodicals, Inc.


Huffaker R.K.,Scott and White Memorial Hospital and Clinic | Yandell P.M.,Scott and White Memorial Hospital and Clinic | Shull B.L.,Scott and White Memorial Hospital and Clinic
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2010

A 73-year-old para 3 white female with posthysterectomy pelvic organ prolapse and stress urinary incontinence underwent pelvic reconstructive surgery and placement of tension-free vaginal tape. On postoperative day 4, she underwent exploratory laparotomy for small bowel obstruction. She was found to have an injury to the small bowel secondary to a through-and-through perforation by tension-free vaginal tape. The entire tape was removed. Partial small bowel resection and primary anastomosis were performed. Her subsequent recovery was uneventful. © 2009 The International Urogynecological Association.

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