[Partial rupture of muscles in young subjects--soldiers and athletes].
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Adult↗
Biomedical subjects
R Kandel
Publications and source records attributed to R Kandel.
Malignant gastrointestinal stromal tumors of the small intestine: a review of 50 cases from a prospective database.
BACKGROUND: Malignant gastrointestinal stromal tumors (M-GIST) are rare mesenchymal tumors originating in the wall of the gastrointestinal (GI) tract. Previous studies have included limited numbers of patients, and most included malignant and benign cases from throughout the GI tract. We reviewed the experience of a single tertiary cancer care center with M-GIST of the small intestine only. METHODS: A prospective database identified all patients seen from 1989 to 1998. Clinical and pathological data, treatment, and outcome were analyzed. Overall median follow-up time was 24 months (range, 1-176 months). RESULTS: Fifty patients (31 male, 19 female) were identified. Mean age at diagnosis was 55 years. Disease was localized in 11 patients, locally advanced (invasion into adjacent organs/peritoneum) in 24 patients, perforated in 4 patients, multiple primary lesions in 2 patients, and distant metastases in 9 patients. All patients underwent resection, which was complete in 70%. Locoregional recurrence (LR) developed in 43% (median, 25 months), and distant metastases in 59% (median, 21 months) of patients at risk. At last follow-up, 14 patients were alive (6 disease-free), 2 had died disease-free, and 34 died with recurrent disease. Overall survival (OS) was similar for localized and locally advanced disease; OS also was similar for patients with multiple primaries and distant metastases at diagnosis. Patients were grouped into three stages: (I) patients with localized and locally advanced disease; (II) patients with perforated; and (III) patients with multiple primaries and distant metastases. Actuarial OS at 5 years was 41% (n = 50)--42% for those with complete resection and 8% for incomplete resection. Univariable analysis showed that earlier stage at diagnosis (P = .001) and completeness of resection (P = .004) predicted for longer OS. CONCLUSIONS: Most patients with M-GIST of the small intestine relapse following resection, but survival may be prolonged. In univariable analysis, stage at presentation and complete resection were significant prognostic variables for OS; grade was not significant. Localized and locally advanced M-GIST of the small intestine have a mean OS > 5 years. Complete resection should be the goal of initial surgical treatment.
Adult↗
Value of electron microscopy and immunohistochemistry in the diagnosis of soft tissue tumors.
Light microscopy alone is often insufficient to type a soft tissue tumor. In this study 142 consecutive soft tissue tumors (benign or malignant), for which both electron microscopy (EM) and immunohistochemistry (IHC) had been performed, were reviewed to assess the contribution of these two modalities to making the final diagnosis. A tentative diagnosis (58 cases) or differential diagnosis (84 cases) was made following light microscopical examination. Ultrastructural and immunohistochemical features were then reviewed. Overall, EM more often contributed to diagnosing the tumor type than IHC (80 vs. 65%), with a statistically significant difference (p = .001). This was most apparent in high-grade sarcomas (grade III); the contribution of the two modalities was similar in benign and low-grade malignant tumors. IHC more often than EM (33% vs 22%) did not provide information to aid in typing of the tumor. However in 47% of the cases in which one of the two modalities was noncontributory, the other technique was helpful in reaching a diagnosis. These findings suggest that both IHC and EM are necessary to properly evaluate soft tissue tumors.
Adolescent↗
An atypical presentation of Paget's disease in an immunocompromised individual. A case report.
Paget's disease of bone is a localized disorder of bony resorption. The mechanism underlying the development of the disease remains controversial. There is substantial evidence suggesting a genetic basis for Paget's disease in some patients. A viral etiology of Paget's disease has been advocated. A further hypothesis implicating an immunological mechanism for this disease is based on growing evidence reviewed in the text. The presented case showed clinical and X-ray features typical of a very aggressive form of Paget's disease. We hypothesize that the extreme local aggressiveness of this case was secondary to the patient's concomitant immunosuppression due to an extended therapy following renal transplant.
Humans↗