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McKenzie CA, Gupta R, Jackett L, Anderson L, Chen V, Dahlstrom JE, Dray M, Farshid G, Hemmings C, Karim R, Kench JG, Klebe S, Kramer N, Kumarasinghe P, Maclean F, Morey A, Nguyen MA, O'Toole S, Rowbotham B, Salisbury ELC, Scolyer RA, Stewart K, Waring L, Cooper CL, Cooper WA. Looking beyond workforce parity: addressing gender inequity in pathology. Pathology 2023; 55:760-771. [PMID: 37573162 DOI: 10.1016/j.pathol.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/14/2023]
Abstract
While women pathologists have made up over one-third of pathologists in the Australian workforce for over 15 years and at least 50% since 2019, they are under-represented in senior leadership roles, scientific publications, grant recipients, editorial boards, key presentations, and professional awards. This is not unique to pathology and is seen in the broader medical and academic community. Barriers to gender equity and equality in pathology, medicine and academia include gender stereotypes, gender-based discrimination, structural and organisational barriers as well as broader social and cultural barriers. A diverse leadership reflective of the whole professional body and the broader community is important for optimal health outcomes. It is the responsibility and moral duty of individuals and organisations to address any gender disparities, inequities, and inequalities by monitoring, identifying, and acting on gender biases and systemic barriers that hinder appropriate levels of representation by women.
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Affiliation(s)
- Catriona A McKenzie
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | | | - Lyndal Anderson
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Vivien Chen
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Haematology Concord Repatriation and General Hospital, Sydney, NSW, Australia
| | - Jane E Dahlstrom
- ACT Pathology Canberra Health Services, Canberra, ACT, Australia; Australian National University, Canberra, ACT, Australia
| | | | - Gelareh Farshid
- SA Pathology, Adelaide, SA, Australia; University of Adelaide, Adelaide, SA, Australia
| | - Chris Hemmings
- Department of Anatomic Pathology Canterbury Health Laboratories, Christchurch, New Zealand; Department of Pathology and Biomedical Science University of Otago, Christchurch, New Zealand
| | - Rooshdiya Karim
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - James G Kench
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sonja Klebe
- SA Pathology, Adelaide, SA, Australia; Flinders University, Adelaide, SA, Australia
| | | | | | - Fiona Maclean
- Douglass Hanly Moir Pathology Sonic Healthcare, Sydney, NSW, Australia; Macquarie University, Sydney, NSW, Australia
| | - Adrienne Morey
- ACT Pathology Canberra Health Services, Canberra, ACT, Australia; Australian National University, Canberra, ACT, Australia
| | - Minh Anh Nguyen
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Sandra O'Toole
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - Beverley Rowbotham
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia; The University of Queensland, Brisbane, Qld, Australia
| | - Elizabeth L C Salisbury
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia; ICPMR Westmead Hospital, NSW Health Pathology, Westmead, NSW, Australia
| | - Richard A Scolyer
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Caroline L Cooper
- The University of Queensland, Brisbane, Qld, Australia; Pathology Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia
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Khan WB, Gallagher HM, Jayasimhan D, Dray M, Chang CL. The impact of bronchoalveolar lavage on the diagnosis of undifferentiated interstitial lung disease alongside a multidisciplinary discussion. Chron Respir Dis 2023; 20:14799731231196581. [PMID: 37585691 PMCID: PMC10434757 DOI: 10.1177/14799731231196581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Cellular analysis of bronchoalveolar lavage (BAL) fluid may aid diagnosis in patients with undifferentiated interstitial lung disease (ILD). The utility of this test in the diagnostic process in conjunction with a multidisciplinary discussion (MDD) is not known. We aim to assess and compare interobserver agreement and diagnostic confidence before and after presenting BAL results in an ILD-MDD. METHODS Patients undergoing investigations for ILD at Waikato Hospital were recruited. At the ILD-MDD two respiratory physicians and one respiratory radiologist participated in the discussion, and their diagnosis and diagnostic confidence were assessed at four sequential time points. Assessors were blinded to each others diagnosis and diagnostic confidence scores. The four sequential time points were (1) after clinical and radiology presentation; (2) after subsequent MDD; (3) after reviewing BAL results; (4) after final MDD with all results. Interobserver agreements were calculated using Fleiss κ statistic. RESULTS 36 patients were recruited, and 77.8% were male. In the first step, the interobserver agreement was substantial κ = 0.622 (95% CI 0.47-0.77), improving in step 2 following MDD to κ = 0.78 (95% CI 0.624-0.935), in step 3 κ = 0.776 (95% CI 0.614-0.937) and step 4 achieved almost perfect agreement of κ = 0.969 (95% CI 0.828-1.11). The diagnostic confidence for individual and group diagnosis increased with the presentation of BAL with and without multidisciplinary MDD. CONCLUSION We found that BAL cellular analysis improves interobserver agreement and confidence in diagnosis following MDD, thus aiding decision-making in cases with undifferentiated ILD.
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Affiliation(s)
- Wafa B Khan
- Department of Respiratory Medicine, Waikato District Health Board, Hamilton, New Zealand
| | - Harry M Gallagher
- Department of Respiratory Medicine, Waikato District Health Board, Hamilton, New Zealand
| | - Dilip Jayasimhan
- Department of Respiratory Medicine, Waikato District Health Board, Hamilton, New Zealand
| | - Michael Dray
- Department of Pathology, Waikato District Health Board, Hamilton, New Zealand
| | - Catherina L Chang
- Department of Respiratory Medicine, Waikato District Health Board, Hamilton, New Zealand
- Respiratory Research Unit, Waikato District Health Board, Hamilton, New Zealand
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Zhu M, Lin Tay M, Lim KS, Bolam SM, Tuari D, Callon K, Dray M, Cornish J, Woodfield TBF, Munro JT, Coleman B, Musson DS. Novel Growth Factor Combination for Improving Rotator Cuff Repair: A Rat In Vivo Study. Am J Sports Med 2022; 50:1044-1053. [PMID: 35188803 DOI: 10.1177/03635465211072557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The lack of healing at the repaired tendon-bone interface is an important cause of failure after rotator cuff repair. While augmentation with growth factors (GFs) has demonstrated promise, the ideal combination must target all 3 tissue types at the tendon-bone interface. HYPOTHESIS The GF combination of transforming growth factor beta 1, Insulin-like growth factor 1, and parathyroid hormone will promote tenocyte proliferation and differentiation and improve the biomechanical and histological quality of the repaired tendon-bone interface. STUDY DESIGN Controlled laboratory study. METHODS In vitro, human tenocytes were cultured in the presence of the GF combination for 72 hours, and cell growth assays and the expression of genes specific to tendon, cartilage, and bone were analyzed. In vivo, adult rats (N = 46) underwent detachment and repair of the left supraspinatus tendon. A PVA-tyramine gel was used to deliver the GF combination to the tendon-bone interface. Histological, biomechanical, and RNA microarray analysis was performed at 6 and 12 weeks after surgery. Immunohistochemistry for type II and X collagen was performed at 12 weeks. RESULTS When treated with the GF combination in vitro, human tenocytes proliferated 1.5 times more than control (P = .04). The expression of scleraxis increased 65-fold (P = .013). The expression of Sox-9 (P = .011), type I collagen (P = .021), fibromodulin (P = .0075), and biglycan (P = .010) was also significantly increased, while the expression of PPARγ was decreased (P = .007). At 6 and 12 weeks postoperatively, the quality of healing on histology was significantly higher in the GF group, with the formation of a more mature tendon-bone interface, as confirmed by immunohistochemistry for type II and X collagen. The GF group achieved a load at failure and Young modulus >1.5 times higher at both time points. Microarrays at 6 weeks demonstrated upregulation of genes involved in leukocyte aggregation (S100A8, S100A9) and tissue mineralization (Bglap, serglycin, Fam20c). CONCLUSION The GF combination promoted protendon and cartilage responses in human tenocytes in vitro; it also improved the histological appearance and mechanical properties of the repair in vivo. Microarrays of the tendon-bone interface identified inflammatory and mineralization pathways affected by the GF combination, providing novel therapeutic targets for further research. CLINICAL RELEVANCE The use of this GF combination is translatable to patients and may improve healing after rotator cuff repair.
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Affiliation(s)
- Mark Zhu
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Mei Lin Tay
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Khoon S Lim
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Scott M Bolam
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Donna Tuari
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Karen Callon
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Michael Dray
- Department of Pathology, Waikato Hospital, Hamilton, New Zealand
| | - Jillian Cornish
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Tim B F Woodfield
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Jacob T Munro
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Brendan Coleman
- Department of Orthopaedic Surgery, Counties Manukau Health, Auckland, New Zealand
| | - David S Musson
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
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Korth K, Bolam S, Leiferman E, Crenshaw T, Dray M, Crawford HA, Wallace M, Halanski MA. Histological and radiographic evaluation of three common tendon transfer techniques in an un-ossified bone porcine model: implications for early anterior tibialis tendon transfers in children with clubfeet. J Child Orthop 2021; 15:443-450. [PMID: 34858530 PMCID: PMC8582610 DOI: 10.1302/1863-2548.15.210076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/15/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To compare the histological healing and radiographic effects of tendons transferred to ossified or unossified bone using different tendon fixation techniques. METHODS Nine new-born piglets underwent bilateral tendon transfers to either the ossified boney calcaneal body or unossified apophysis. The tendons were fixed using metallic suture anchors, sutures alone or a bone tunnel. At six weeks of age, calcanei were harvested, radiologically imaged and then prepared for histology. A semi-quantitative aggregated scoring system with values ranging from 0 (poor) to 15 (excellent), was used to grade healing at the surgical enthesis and the apophyseal ossification was graded by five independent reviewers in triplicate using a modified (1 to 4) validated scoring system. RESULTS Histologically, the cartilaginous transfers utilizing the tunnel and suture techniques also demonstrated the best average aggregated scores of entheses healing rivalling that measured in transfers using the classic bone tunnel technique (clinical benchmark), whereas suture anchor fixation demonstrated the worst healing in both the ossified and unossified samples. All three transfer techniques caused at least minor alterations in apophyseal ossification, with the most significant changes observed in the metallic suture anchor cohort. The tunnel and suture techniques demonstrated similar and more mild abnormalities in ossification. CONCLUSION Tendon transfers to unossified bone heal histologically as well as transfers classically performed through tunnels in bone. Suture fixation or tunnel techniques appear radiographically and histologically superior to suture anchors in our newborn porcine model. LEVEL OF EVIDENCE
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Affiliation(s)
- Kyle Korth
- Department of Orthopaedic Surgery and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Scott Bolam
- Department of Orthopaedic Surgery, Auckland Hospital, Auckland, New Zealand
| | - Ellen Leiferman
- Department of Orthopaedic Surgery and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Thomas Crenshaw
- Department of Animal Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Michael Dray
- Histology Department, Waikato Hospital, Hamilton, New Zealand
| | - Haemish A. Crawford
- Department of Paediatric Orthopaedic Surgery, Starship Children’s Health, Auckland, New Zealand
| | - Maegen Wallace
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Children’s Hospital and Medical Center, Omaha, Nebraska, United States
| | - Matthew A. Halanski
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Children’s Hospital and Medical Center, Omaha, Nebraska, United States
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Dray M, Langguth D, Badrick T. The carbon footprint of pathology testing. Med J Aust 2020; 213:477-477.e1. [PMID: 33098100 DOI: 10.5694/mja2.50830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Michael Dray
- Royal College of Pathologists of Australasia, Sydney, NSW
| | - Daman Langguth
- Royal College of Pathologists of Australasia, Sydney, NSW
| | - Tony Badrick
- Royal College of Pathologists of Australasia Quality Assurance Programs, Sydney, NSW
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Rassie K, Dray M, Michigami T, Cundy T. Bisphosphonate Use and Fractures in Adults with Hypophosphatasia. JBMR Plus 2019; 3:e10223. [PMID: 31687651 PMCID: PMC6820463 DOI: 10.1002/jbm4.10223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/24/2019] [Accepted: 07/15/2019] [Indexed: 02/06/2023] Open
Abstract
Adults with hypophosphatasia (HPP) may suffer femoral fractures resembling the atypical femoral fractures that can occur with long‐term bisphosphonate treatment, and there is an emerging consensus that bisphosphonates should not be used in adults with HPP and low bone mass. However, the spectrum of HPP in adults is wide: ranging from the severely affected—who commonly have osteomalacia—through to the minimally affected. The former typically have biallelic and the latter, heterozygous ALPL mutations. We have reviewed reports of fractures in adults with genetically proven HPP which suggest that the risk of fracture is at least 200‐fold greater in those with biallelic mutations. We also discuss two cases of postmenopausal women with heterozygous ALPL mutations. One had fractures and severe osteoporosis, but histology revealed no evidence of osteomalacia. The second had taken alendronate for 8 years, but despite profound suppression of bone turnover, histology again revealed no evidence of osteomalacia. The management of adults with HPP who have coexisting osteoporosis is challenging. More data are clearly needed, but we suggest that the risks of bisphosphonate therapy may be relatively low in patients who have heterozygous mutations and no histological evidence of osteomalacia. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Kate Rassie
- Department of Endocrinology Greenlane Clinical Centre Auckland New Zealand
| | - Michael Dray
- Department of Pathology Waikato Hospital Hamilton New Zealand
| | - Toshimi Michigami
- Department of Bone & Mineral Research Osaka Women's & Children's Hospital Isumi Japan
| | - Tim Cundy
- Department of Endocrinology Greenlane Clinical Centre Auckland New Zealand.,Department of Medicine, Faculty of Medical & Health Sciences University of Auckland Auckland New Zealand
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Cundy T, Dray M, Delahunt J, Hald JD, Langdahl B, Li C, Szybowska M, Mohammed S, Duncan EL, McInerney-Leo AM, Wheeler PG, Roschger P, Klaushofer K, Rai J, Weis M, Eyre D, Schwarze U, Byers PH. Mutations That Alter the Carboxy-Terminal-Propeptide Cleavage Site of the Chains of Type I Procollagen Are Associated With a Unique Osteogenesis Imperfecta Phenotype. J Bone Miner Res 2018; 33:1260-1271. [PMID: 29669177 PMCID: PMC6031457 DOI: 10.1002/jbmr.3424] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/25/2018] [Accepted: 03/06/2018] [Indexed: 01/28/2023]
Abstract
Osteogenesis imperfecta (OI) is a genetic bone disorder characterized by fractures, low bone mass, and skeletal fragility. It most commonly arises from dominantly inherited mutations in the genes COL1A1 and COL1A2 that encode the chains of type I collagen. A number of recent reports have suggested that mutations affecting the carboxyl-terminal propeptide cleavage site in the products of either COL1A1 or COL1A2 give rise to a form of OI characterized by unusually dense bones. We have assembled clinical, biochemical, and molecular data from 29 individuals from 8 families with 7 different mutations affecting the C-propeptide cleavage site. The phenotype was generally mild: The median height was ∼33th centile. Eighty percent of subjects had their first fracture by the age of 10 years, and one-third had a femoral or tibial fracture by the age of 25 years. Fractures continued into adulthood, though rates varied considerably. Healing was normal and rarely resulted in long bone deformity. One-third of subjects older than 15 years had scoliosis. The teeth and hearing were normal in most, and blue sclerae were not observed. Other features noted included fibro-osseous dysplasia of the mandible and Achilles tendon calcification. The mean spinal bone mineral density Z-score was +2.9 (SD 2.1) compared with -2.2 (0.7) in subjects with COL1A1 haploinsufficiency mutations. Bone mineral density distribution, assessed by quantitative backscattered electron imaging in bone showed higher levels of mineralization than found in any other disorder. Bone histology showed high trabecular volume and increased cortical thickness, with hyperosteoidosis and delayed mineralization. In vitro studies with cultured skin fibroblasts suggested that these mutations interfere with processing of the chain in which the sequence alteration occurs, but the C-propeptide is eventually cleaved (and detectable in blood), suggesting there are alternative sites of cleavage. The precise mechanism of the bony pathology is not yet clear. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Tim Cundy
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michael Dray
- Histology Department, Waikato Hospital, Hamilton, New Zealand
| | - John Delahunt
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jannie Dahl Hald
- Department of Endocrinology and Metabolism, Aarhus University Hospital, Aarhus, Denmark
| | - Bente Langdahl
- Department of Endocrinology and Metabolism, Aarhus University Hospital, Aarhus, Denmark
| | - Chumei Li
- McMaster University Medical Center, Hamilton, Canada
| | | | | | - Emma L Duncan
- Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Aideen M McInerney-Leo
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Woolloongabba, Queensland University of Technology, Woolloongabba, Australia
| | | | - Paul Roschger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Jyoti Rai
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - MaryAnn Weis
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - David Eyre
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Ulrike Schwarze
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Peter H Byers
- Department of Pathology, University of Washington, Seattle, WA, USA.,Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA, USA
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Elston MS, Sehgal S, Dray M, Phillips E, Conaglen JV, Clifton-Bligh RJ, Gill AJ. A Duodenal SDH-Deficient Gastrointestinal Stromal Tumor in a Patient With a Germline SDHB Mutation. J Clin Endocrinol Metab 2017; 102:1447-1450. [PMID: 28324028 DOI: 10.1210/jc.2017-00165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/09/2017] [Indexed: 02/13/2023]
Abstract
CONTEXT Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract arising from the interstitial cells of Cajal. Succinate dehydrogenase (SDH)-deficient GISTs are a unique class of GIST defined by loss of immunohistochemical expression of SDHB, indicating dysfunction of the mitochondrial complex 2; lack of driver mutations in KIT and PDGFRA; and distinctive morphologic features and natural history. To date, all reported SDH-deficient GISTs have arisen in the stomach. We report an SDH-deficient GIST arising in the gastrointestinal tract outside the stomach. CASE DESCRIPTION A 29-year-old man with a germline SDHB mutation (p.Arg90*) presented with acute upper gastrointestinal hemorrhage. Endoscopy identified a lesion in the second part of the duodenum, close to the distal common bile duct, consistent with a GIST. Endoscopic ultrasonography and magnetic resonance imaging did not demonstrate metastatic or nodal disease. Open transduodenal excision was performed to remove the tumor. Histologic evaluation confirmed the clinical diagnosis of a GIST, with positive staining for DOG1 and KIT. The mitotic count was low (1 per 50 high-power fields). Immunohistochemistry for SDHB was negative in the presence of an internal control. SDHA expression was retained. No somatic mutations were identified in KIT (exons 9, 11, 13, and 17) or PDGFRA (exons 12, 14, and 18). The germline SDHB mutation and loss of heterozygosity were confirmed on molecular testing of the tumor. CONCLUSION We describe an SDH-deficient GIST occurring outside of the stomach. This case indicates that SDH-deficient GISTs may also arise in the small intestine.
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Affiliation(s)
- Marianne S Elston
- Department of Endocrinology, Waikato Hospital, Hamilton 3240, New Zealand
- Waikato Clinical Campus, University of Auckland, Hamilton 3240, New Zealand
| | - Shekhar Sehgal
- Department of Endocrinology, Waikato Hospital, Hamilton 3240, New Zealand
| | - Michael Dray
- Department of Anatomical Pathology, Waikato Hospital, Hamilton 3240, New Zealand
| | - Elizabeth Phillips
- Department of Gastroenterology, Waikato Hospital, Hamilton 3240, New Zealand
| | - John V Conaglen
- Waikato Clinical Campus, University of Auckland, Hamilton 3240, New Zealand
| | - Roderick J Clifton-Bligh
- Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards 2065, Australia
- Department of Medicine, University of Sydney, Sydney 2006, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards 2065, Australia
- Sydney Medical School, University of Sydney, Sydney 2006, Australia
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Gao R, Watson M, Callon KE, Tuari D, Dray M, Naot D, Amirapu S, Munro JT, Cornish J, Musson DS. Local application of lactoferrin promotes bone regeneration in a rat critical-sized calvarial defect model as demonstrated by micro-CT and histological analysis. J Tissue Eng Regen Med 2017; 12:e620-e626. [PMID: 27860377 PMCID: PMC5811776 DOI: 10.1002/term.2348] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/30/2016] [Accepted: 11/08/2016] [Indexed: 12/20/2022]
Abstract
Lactoferrin is a multifunctional glycoprotein with therapeutic potential for bone tissue engineering. The aim of this study was to assess the efficacy of local application of lactoferrin on bone regeneration. Five‐millimetre critical‐sized defects were created over the right parietal bone in 64 Sprague–Dawley rats. The rats were randomized into four groups: group 1 (n = 20) had empty defects; group 2 (n = 20) had defects grafted with collagen gels (3 mg/ml); group 3 (n = 20) had defects grafted with collagen gels impregnated with bovine lactoferrin (10 μg/gel); and group 4 (n = 4) had sham surgeries (skin and periosteal incisions only). The rats were sacrificed at 4 or 12 weeks post‐operatively, and the calvaria were excised and evaluated with micro‐CT (Skyscan 1172) followed by histology. The bone volume fraction (BV/TV) was higher in lactoferrin‐treated animals at both timepoints, with groups 1, 2, 3 and 4 measuring 10.5 ± 1.1%, 8.6 ± 1.4%, 16.5 ± 0.6% and 24.27 ± 2.6%, respectively, at 4 weeks (P < 0.05); and 12.2 ± 1.3%, 13.6 ± 1.5%, 21.9 ± 1.2% and 29.3 ± 0.8%, respectively, at 12 weeks (P < 0.05). Histological analysis revealed that the newly formed bone within the calvarial defects of all groups was a mixture of woven and lamellar bone, with more bone in the group treated with lactoferrin at both timepoints. Our study demonstrated that local application of lactoferrin significantly increased bone regeneration in a rat critical‐sized calvarial defect model. The profound effect of lactoferrin on bone regeneration has therapeutic potential to improve the poor clinical outcomes associated with bony non‐union. LF In Vivo JTERM Authors Contributions. Copyright © 2016 The Authors Journal of Tissue Engineering and Regenerative Medicine Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Ryan Gao
- Bone and Joint Research Group, University of Auckland, Auckland, New Zealand
| | - Maureen Watson
- Bone and Joint Research Group, University of Auckland, Auckland, New Zealand
| | - Karen E Callon
- Bone and Joint Research Group, University of Auckland, Auckland, New Zealand
| | - Donna Tuari
- Bone and Joint Research Group, University of Auckland, Auckland, New Zealand
| | - Michael Dray
- Waikato District Health Board, Waikato, New Zealand
| | - Dorit Naot
- Bone and Joint Research Group, University of Auckland, Auckland, New Zealand
| | - Satya Amirapu
- Department of Anatomy, University of Auckland, Auckland, New Zealand
| | - Jacob T Munro
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Jillian Cornish
- Bone and Joint Research Group, University of Auckland, Auckland, New Zealand
| | - David S Musson
- Bone and Joint Research Group, University of Auckland, Auckland, New Zealand
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Chhana A, Doyle A, Sevao A, Amirapu S, Riordan P, Dray M, McGlashan S, Cornish J, Dalbeth N. Advanced imaging assessment of gout: comparison of dual-energy CT and MRI with anatomical pathology. Ann Rheum Dis 2017; 77:629-630. [PMID: 28283513 DOI: 10.1136/annrheumdis-2017-211343] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Ashika Chhana
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anthony Doyle
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Amy Sevao
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Satya Amirapu
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Peter Riordan
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Michael Dray
- Histology Department, Waikato Hospital, Hamilton, New Zealand
| | - Sue McGlashan
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Jillian Cornish
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
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Mweempwa A, Tan A, Dray M. Recurrent Merkel cell carcinoma of the testis with unknown primary site: a case report. J Med Case Rep 2016; 10:314. [PMID: 27814751 PMCID: PMC5097413 DOI: 10.1186/s13256-016-1102-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/12/2016] [Indexed: 01/09/2023] Open
Abstract
Background Merkel cell carcinoma is a rare and aggressive neuroendocrine tumor that commonly arises in the skin. It is rare for it to occur in the testes. There are only seven cases of testicular Merkel cell carcinoma reported in the literature. Case presentation A 66-year-old Maori man presented to our hospital with left testicular swelling. His alpha-fetoprotein and beta-human chorionic gonadotrophin levels were within normal limits. His lactate dehydrogenase concentration was elevated to 267 U/L. Ultrasound imaging confirmed a large testicular mass, and he underwent left orchiectomy. His histological examination revealed a neuroendocrine tumor with an immunostaining pattern suggesting Merkel cell carcinoma. He presented to our hospital again 3 months later with right testicular swelling that was confirmed on ultrasound sonography to be a tumor. He underwent a right orchiectomy, and his histological examination revealed metastatic Merkel cell carcinoma. A primary lesion was not identified, and computed tomographic imaging did not reveal spread to other organs. He received six cycles of adjuvant carboplatin and etoposide chemotherapy and remained disease-free 18 months after completion of chemotherapy. Conclusions Given the paucity of studies, standard adjuvant treatment for testicular Merkel cell carcinoma remains uncertain, although platinum-based chemotherapy seems to be an appropriate option. Electronic supplementary material The online version of this article (doi:10.1186/s13256-016-1102-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Angela Mweempwa
- Medical Oncology, Waikato Hospital, Selwyn Street and Pembroke Street, Hamilton, 3204, New Zealand.
| | - Alvin Tan
- Medical Oncology, Waikato Hospital, Selwyn Street and Pembroke Street, Hamilton, 3204, New Zealand
| | - Michael Dray
- Histology Department, Waikato Hospital, Selwyn Street and Pembroke Street, Hamilton, 3204, New Zealand
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12
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Street M, Thambyah A, Dray M, Amirapu S, Tuari D, Callon KE, McIntosh JD, Burkert K, Dunbar PR, Coleman B, Cornish J, Musson DS. Augmentation with an ovine forestomach matrix scaffold improves histological outcomes of rotator cuff repair in a rat model. J Orthop Surg Res 2015; 10:165. [PMID: 26482900 PMCID: PMC4615320 DOI: 10.1186/s13018-015-0303-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/11/2015] [Indexed: 01/08/2023] Open
Abstract
Background Rotator cuff tears can cause significant pain and functional impairment. Without surgical repair, the rotator cuff has little healing potential, and following surgical repair, they are highly prone to re-rupture. Augmenting such repairs with a biomaterial scaffold has been suggested as a potential solution. Extracellular matrix (ECM)-based scaffolds are the most commonly used rotator cuff augments, although to date, reports on their success are variable. Here, we utilize pre-clinical in vitro and in vivo assays to assess the efficacy of a novel biomaterial scaffold, ovine forestomach extracellular matrix (OFM), in augmenting rotator cuff repair. Methods OFM was assessed in vitro for primary tenocyte growth and adherence, and for immunogenicity using an assay of primary human dendritic cell activation. In vivo, using a murine model, supraspinatus tendon repairs were carried out in 34 animals. Augmentation with OFM was compared to sham surgery and unaugmented control. At 6- and 12-week time points, the repairs were analysed biomechanically for strength of repair and histologically for quality of healing. Results OFM supported tenocyte growth in vitro and did not cause an immunogenic response. Augmentation with OFM improved the quality of healing of the repaired tendon, with no evidence of excessive inflammatory response. However, there was no biomechanical advantage of augmentation. Conclusions The ideal rotator cuff tendon augment has not yet been identified or clinically implemented. ECM scaffolds offer a promising solution to a difficult clinical problem. Here, we have shown improved histological healing with OFM augmentation. Identifying materials that offset the poorer mechanical properties of the rotator cuff post-injury/repair and enhance organised tendon healing will be paramount to incorporating augmentation into surgical treatment of the rotator cuff.
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Affiliation(s)
- Matthew Street
- Department of Medicine, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Ashvin Thambyah
- Faculty of Engineering, University of Auckland, Auckland, 1142, New Zealand.
| | - Michael Dray
- Waikato District Health Board, Waikato Hospital, Hamilton, 3204, New Zealand.
| | - Satya Amirapu
- Department of Anatomy with Radiology, The University of Auckland, Auckland, 1142, New Zealand.
| | - Donna Tuari
- Department of Medicine, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Karen E Callon
- Department of Medicine, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Julie D McIntosh
- School of Biological Sciences, The University of Auckland, Auckland, 1142, New Zealand. .,Maurice Wilkins Centre, University of Auckland, Private Bag 92014, Auckland, New Zealand.
| | - Kristina Burkert
- School of Biological Sciences, The University of Auckland, Auckland, 1142, New Zealand. .,Maurice Wilkins Centre, University of Auckland, Private Bag 92014, Auckland, New Zealand.
| | - P Rod Dunbar
- School of Biological Sciences, The University of Auckland, Auckland, 1142, New Zealand. .,Maurice Wilkins Centre, University of Auckland, Private Bag 92014, Auckland, New Zealand.
| | - Brendan Coleman
- Department of Orthopaedics, Middlemore Hospital, Private Bag 93311, Auckland, New Zealand.
| | - Jillian Cornish
- Department of Medicine, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - David S Musson
- Department of Medicine, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
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Cundy T, Michigami T, Tachikawa K, Dray M, Collins JF, Paschalis EP, Gamsjaeger S, Roschger A, Fratzl-Zelman N, Roschger P, Klaushofer K. Reversible Deterioration in Hypophosphatasia Caused by Renal Failure With Bisphosphonate Treatment. J Bone Miner Res 2015; 30:1726-37. [PMID: 25736332 DOI: 10.1002/jbmr.2495] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/21/2015] [Accepted: 02/24/2015] [Indexed: 11/10/2022]
Abstract
Hypophosphatasia is an inborn error of metabolism caused by mutations in the ALPL gene. It is characterized by low serum alkaline phosphatase (ALP) activity and defective mineralization of bone, but the phenotype varies greatly in severity depending on the degree of residual enzyme activity. We describe a man with compound heterozygous mutations in ALPL, but no previous bone disease, who suffered numerous disabling fractures after he developed progressive renal failure (for which he eventually needed dialysis treatment) and was prescribed alendronate treatment. A bone biopsy showed marked osteomalacia with low osteoblast numbers and greatly elevated pyrophosphate concentrations at mineralizing surfaces. In vitro testing showed that one mutation, T117H, produced an ALP protein with almost no enzyme activity; the second, G438S, produced a protein with normal activity, but its activity was inhibited by raising the media phosphate concentration, suggesting that phosphate retention (attributable to uremia) could have contributed to the phenotypic change, although a pathogenic effect of bisphosphonate treatment is also likely. Alendronate treatment was discontinued and, while a suitable kidney donor was sought, the patient was treated for 6 months with teriparatide, which significantly reduced the osteomalacia. Eighteen months after successful renal transplantation, the patient was free of symptoms and the scintigraphic bone lesions had resolved. A third bone biopsy showed marked hyperosteoidosis but with plentiful new bone formation and a normal bone formation rate. This case illustrates how pharmacological (bisphosphonate treatment) and physiologic (renal failure) changes in the "environment" can dramatically affect the phenotype of a genetic disorder.
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Affiliation(s)
- Tim Cundy
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Aukland, New Zealand
| | - Toshimi Michigami
- Department of Bone and Mineral Research, Osaka Medical Center for Maternal and Child Health, Osaka, Japan
| | - Kanako Tachikawa
- Department of Bone and Mineral Research, Osaka Medical Center for Maternal and Child Health, Osaka, Japan
| | - Michael Dray
- Department of Pathology, Middlemore Hospital, Auckland, New Zealand
| | - John F Collins
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Eleftherios P Paschalis
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Sonja Gamsjaeger
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Andreas Roschger
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Nadja Fratzl-Zelman
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Paul Roschger
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
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Chhana A, Callon KE, Dray M, Pool B, Naot D, Gamble GD, Coleman B, McCarthy G, McQueen FM, Cornish J, Dalbeth N. Interactions between tenocytes and monosodium urate monohydrate crystals: implications for tendon involvement in gout. Ann Rheum Dis 2014; 73:1737-41. [PMID: 24709860 DOI: 10.1136/annrheumdis-2013-204657] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Advanced imaging studies have demonstrated that urate deposition in periarticular structures, such as tendons, is common in gout. The aim of this study was to investigate the effects of monosodium urate monohydrate (MSU) crystals on tenocyte viability and function. METHODS The histological appearance of tendons in joints affected by advanced gout was examined using light microscopy. In vitro, colorimetric assays and flow cytometry were used to assess cell viability in primary rat and primary human tenocytes cultured with MSU crystals. Real-time PCR was used to determine changes in the relative mRNA expression levels of tendon-related genes, and Sirius red staining was used to measure changes in collagen deposition in primary rat tenocytes. RESULTS In joint samples from patients with gout, MSU crystals were identified within the tendon, adjacent to and invading into tendon, and at the enthesis. MSU crystals reduced tenocyte viability in a dose-dependent manner. MSU crystals decreased the mRNA expression of tendon collagens, matrix proteins and degradative enzymes and reduced collagen protein deposition by tenocytes. CONCLUSIONS These data indicate that MSU crystals directly interact with tenocytes to reduce cell viability and function. These interactions may contribute to tendon damage in people with advanced gout.
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Affiliation(s)
- Ashika Chhana
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Karen E Callon
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Michael Dray
- Department of Histology, Waikato Hospital, Hamilton, New Zealand
| | - Bregina Pool
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Dorit Naot
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Greg D Gamble
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Brendan Coleman
- Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Geraldine McCarthy
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Fiona M McQueen
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Jillian Cornish
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
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Houang M, Clarkson A, Sioson L, Elston MS, Clifton-Bligh RJ, Dray M, Ranchere-Vince D, Decouvelaere AV, de la Fouchardiere A, Gill AJ. Phosphaturic mesenchymal tumors show positive staining for somatostatin receptor 2A (SSTR2A). Hum Pathol 2013; 44:2711-8. [DOI: 10.1016/j.humpath.2013.07.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
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16
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Sreenivasan D, Watson M, Callon K, Dray M, Das R, Grey A, Cornish J, Fernandez J. Integrating micro CT indices, CT imaging and computational modelling to assess the mechanical performance of fluoride treated bone. Med Eng Phys 2013; 35:1793-800. [DOI: 10.1016/j.medengphy.2013.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 07/30/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
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17
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Chhana A, Callon KE, Pool B, Naot D, Gamble GD, Dray M, Pitto R, Bentley J, McQueen FM, Cornish J, Dalbeth N. The Effects of Monosodium Urate Monohydrate Crystals on Chondrocyte Viability and Function: Implications for Development of Cartilage Damage in Gout. J Rheumatol 2013; 40:2067-74. [DOI: 10.3899/jrheum.130708] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Cartilage damage is frequently observed in advanced destructive gout. The aim of our study was to investigate the effects of monosodium urate monohydrate (MSU) crystals on chondrocyte viability and function.Methods.The alamarBlue assay and flow cytometry were used to assess the viability of primary human chondrocytes and cartilage explants following culture with MSU crystals. The number of dead chondrocytes in cartilage explants cultured with MSU crystals was quantified. Real-time PCR was used to determine changes in the relative mRNA expression levels of chondrocytic genes. The histological appearance of cartilage in joints affected by gout was also examined.Results.MSU crystals rapidly reduced primary human chondrocyte and cartilage explant viability in a dose-dependent manner (p < 0.01 for both). Cartilage explants cultured with MSU crystals had a greater percentage of dead chondrocytes at the articular surface compared to untreated cartilage (p = 0.004). Relative mRNA expression of type II collagen and the cartilage matrix proteins aggrecan and versican was decreased in chondrocytes following culture with MSU crystals (p < 0.05 for all). However, expression of the degradative enzymes ADAMTS4 and ADAMTS5 was increased (p < 0.05 for both). In joints affected by gout, normal cartilage architecture was lost, with empty chondrocyte lacunae observed.Conclusion.MSU crystals have profound inhibitory effects on chondrocyte viability and function. Interactions between MSU crystals and chondrocytes may contribute to cartilage damage in gout through reduction of chondrocyte viability and promotion of a catabolic state.
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Grey A, Garg S, Dray M, Purvis L, Horne A, Callon K, Gamble G, Bolland M, Reid IR, Cundy T. Low-dose fluoride in postmenopausal women: a randomized controlled trial. J Clin Endocrinol Metab 2013; 98:2301-7. [PMID: 23553866 DOI: 10.1210/jc.2012-4062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Trials of high-dose fluoride have reported increased bone formation and bone mineral density (BMD), but impaired bone mineralization and either adverse or neutral effects on fracture risk. Meta-analysis of a heterogeneous dataset of small trials suggests that daily doses of <20 mg fluoride might reduce fracture risk, but it is not known whether low doses of fluoride are safely anabolic to bone. OBJECTIVE We set out to investigate the skeletal effects of low doses of fluoride. DESIGN, SETTING, AND PARTICIPANTS We conducted a double-blind, placebo-controlled randomized trial over 1 year at an academic research center, in 180 postmenopausal women with osteopenia. INTERVENTION Participants received daily treatment with tablets containing placebo, 2.5 mg fluoride, 5 mg fluoride, or 10 mg fluoride. MAIN OUTCOME MEASURES The primary endpoint was a change in lumbar spine BMD at 1 year; secondary endpoints were hip and forearm BMD, and markers of bone turnover. Safety was assessed by histomorphometric analysis of transiliac bone biopsies from a subset of participants. RESULTS Compared to placebo, none of the doses of fluoride altered BMD at any site. The bone formation marker, procollagen type I N-terminal propeptide, increased significantly in the 5 mg and 10 mg fluoride groups compared to placebo (P = .04 and .005, respectively). No differences were observed between placebo and any of the fluoride groups in levels of β-C-terminal telopeptide of type I collagen. CONCLUSIONS Low-dose fluoride does not induce substantial effects on surrogates of skeletal health and is unlikely to be an effective therapy for osteoporosis.
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Affiliation(s)
- Andrew Grey
- University of Auckland, Department of Medicine, Private Bag 92019, Auckland, New Zealand.
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19
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Chhana A, Callon K, Dray M, Pool B, Naot D, Gamble G, Coleman B, McQueen F, Cornish J, Dalbeth N. Monosodium urate crystals inhibit tenocyte viability and function: implications for periarticular involvement in chronic gout. ACTA ACUST UNITED AC 2013. [DOI: 10.1530/boneabs.1.pp21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Weerakkody YD, Dray M, Pinto C, Rosenfeldt M, Flint M. Musculoskeletal CPD revision: cases from the New Zealand bone and soft tissue tumour registry. J Med Imaging Radiat Oncol 2012; 56:96-9. [PMID: 22339752 DOI: 10.1111/j.1754-9485.2011.02284.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The following case report was selected from the New Zealand Bone and Soft Tissue Tumour Registry to highlight some key concepts and findings in musculoskeletal imaging with radiological-pathological correlation. The presentation follows a question and answer format followed by clinical information, selected images, diagnosis, discussion and teaching points.
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Dray M. How i handle bone specimens: a case based presentation. Pathology 2012. [DOI: 10.1016/s0031-3025(16)32621-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dray M, Pinto C. An approach to lucent lesions of bone: a case based presentation with radiological and histopathological correlation. Pathology 2012. [DOI: 10.1016/s0031-3025(16)32622-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chard K, Dray M, Eaton P, Pinto C. Musculoskeletal CPD revision: cases from the New Zealand Bone & Soft Tissue Tumour Registry. J Med Imaging Radiat Oncol 2009; 53:296-300. [PMID: 19624296 DOI: 10.1111/j.1754-9485.2009.02077.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This case report has been selected from the New Zealand Bone & Soft Tissue Tumour Registry to highlight some key concepts and findings in musculoskeletal imaging with radiological-pathological correlation. The case is presented in a question and answer format, with clinical information and selected images in one section, followed by the diagnosis, discussion and teaching points.
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Affiliation(s)
- K Chard
- Department of Radiology, Middlemore Hospital, Hospital Road, Otahuhu, Auckland, New Zealand.
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24
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Dray M, Russell P. The use of p16INK4a as an adjunct to the interpretation of cervical biopsies: authors’ reply. Pathology 2006. [DOI: 10.1080/00313020600564603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The susceptibility of 4,929 unselected clinical isolates of bacteria to cefoxitin and cephalothin was determined by the single-disk method, using a computer-associated electronic zone analyzer to obtain, record, and process measurements of sizes of zones of inhibition. Both cefoxitin and cephalothin were effective against most gram-positive strains, including Staphylococcus aureus, S. epidermidis, micrococci, and all streptococci except enterococci. The three strains of Listeria monocytogenes tested were susceptible to cephalothin but resistant to cefoxitin. There was little difference between the cefoxitin and cephalothin susceptibility of Salmonellae, Citrobacter sp., Enterobacter sp., Proteus mirabilis, and Pseudomonas sp. Cefoxitin was more effective then cephalothin against Escherichia coli, Klebsiella sp., Serratia sp., indole-positive Proteus sp., Providence sp., Flavobacter sp., Herellea vaginicola, and Mima polymorpha. Cefoxitin also appeared to exhibit enhanced activity, as compared with cephalothin, against Bacteroides sp. Thus cefoxitin appears to have a very broad antibacterial spectrum which is greater than that of cephalothin, especially against gram-negative strains.
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Dray M, Russell P, Dalrymple C, Wallman N, Angus G, Leong A, Carter J, Cheerala B. p16iNK4a as a complementary marker of high-grade intraepithelial lesions of the uterine cervix. I: Experience with squamous lesions in 189 consecutive cervical biopsies. Pathology 2005; 37:112-24. [PMID: 16028838 DOI: 10.1080/00313020500058607] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To test the usefulness of p16(INK4a) immunostaining for improving the diagnostic accuracy of cervical punch biopsies referred to a routine laboratory setting during the investigation of women with abnormal Papanicolaou smears. METHODS A total of 188 consecutive and unselected colposcopically directed cervical biopsies and a single contemporaneous cervical polyp were accessioned prospectively over a 3-month period, step-serially sectioned and examined by H&E and immunostained for p16(INK4a). The clinical context, results of concurrent Papanicolaou smears/ThinPrep slides and Digene hybrid capture tests for high-risk human papillomavirus (HPV) subtypes, as well as follow-up cervical smears/ThinPrep, biopsies and loop excisions of transformation zones or cone biopsies were all correlated with the morphological and immunohistochemical findings. RESULTS Seventy-seven biopsies (40.7%) displayed a high-grade squamous intraepithelial lesion (HGSIL; cervical intraepithelial neoplasia [CIN] 2-3), 27 (14.3%) showed a low grade squamous intraepithelial lesion (HPV +/- CIN1) and 85 (45%) showed a range of non-dysplastic (inflammatory or reactive) changes. Diffuse strong parabasal immunostaining for p16(INK4a), suggestive of integrated high-risk HPV DNA into the host genome, was observed in 81 biopsies (42.9%, including the cervical polyp) and correlated (>90%) with HGSIL in the H&E sections. Only one case revealed irreconcilable discordance between the histological features and this strong parabasal immunostaining pattern. Focal and weaker midzonal or superficial p16(INK4a) immunostaining, suggestive of episomal HPV infection, was noted in 19 biopsies (10%) and these biopsies exhibited a range of histological changes but predominantly low grade squamous intraepithelial lesion (LGSIL). No staining of the squamous epithelium was seen in 89 biopsies (47.1%). Again, only one case revealed irreconcilable discordance between the histological features and this negative immunostaining pattern. On review of all cases where discordant results were noted between the H&E appearances and expected p16(INK4a) immunostaining, we found 26 cases (13.7%) in which this discordance prompted justifiable modification of the original diagnosis. CONCLUSIONS Thus, within a routine diagnostic laboratory, p16(INK4a) immunostaining appears to be a very useful adjunctive test in the examination of colposcopically directed cervical biopsies, in the diagnostic cascade of women investigated for abnormal Papanicolaou smears. It is possible, as further data accumulate concerning the importance of integration of high-risk HPV DNA into the host cell genome and the reliability with which this can be identified by p16(INK4a) immunostaining, that this will become the diagnostic 'lesion of interest', replacing the subjective histological grading of cervical dysplasia, in the management of such patients; i.e., the discriminatory watershed between continued surveillance and active intervention.
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Affiliation(s)
- Michael Dray
- Mayne Health Laverty Pathology, Sydney, New South Wales, Australia
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27
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Dray M. Recent Advances in Histopathology 20. Pathology 2004. [DOI: 10.1016/s0031-3025(16)39689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Allen B, Campbell I, Desai S, Dray M, Scarlet J. Pilot study comparing the accuracy of lymphoscintigraphy sentinel lymph node localisation with axillary node dissection in women with operable breast cancer. N Z Med J 2001; 114:233-6. [PMID: 11453361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
AIM To evaluate the use of lymphoscintigraphy sentinel lymph node mapping with scintillation gamma probe detection and blue dye assisted sentinel lymph node biopsy in patients with invasive breast cancer. To compare the lymph nodes detected lymphosintigraphically and at surgery for invasive breast cancer and the accuracy of sentinel node prediction of axillary status. METHODS A prospective pilot study was performed on 36 women diagnosed with invasive breast cancer requiring axillary node dissection. Lymphoscintigraphy involving peritumoral injection of 99mTechnetium antimony sulphide or rhenium sulphur colloid was performed prior to surgery. Sentinel lymph node biopsy was then performed using gamma probe and blue dye localisation. RESULTS Sentinel lymph nodes were identified on lymphoscintigrams in 100% of cases, and sentinel nodes located surgically in 34/36 (94.4%) of patients. All women with positive axillary lymph nodes on axillary dissection were correctly identified on sentinel node biopsy. Eight patients demonstrated internal mammary (IM) node radiocolloid uptake, one returning positive IM histology in the presence of positive axillary sentinel node metastasis. CONCLUSION A high proportion of sentinel nodes were demonstrated by lymphoscintigraphy and were subsequently removed surgically. When internal mammary nodes are identified surgical removal should be considered. In this small series sentinel lymph node status correctly predicted axillary node status in 100% of patients for whom sentinel nodes were retrieved supporting the concept of sentinel node biopsy only for women with normal sentinel lymph nodes. Evidence from randomised trials that sentinel node based management does not compromise regional control of breast cancer or survival, is awaited.
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Affiliation(s)
- B Allen
- Department of Nuclear Medicine, Waikato Hospital, Hamilton
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Mayall F, Dray M, Stanley D, Harrison B, Allen R. Immunoflow cytometry and cell block immunohistochemistry in the FNA diagnosis of lymphoma: a review of 73 consecutive cases. J Clin Pathol 2000; 53:451-7. [PMID: 10911803 PMCID: PMC1731207 DOI: 10.1136/jcp.53.6.451] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To review the results of 73 consecutive fine needle aspirations (FNAs) that were collected by a pathologist and analysed by immunoflow cytometry. Material for a cell block was also collected from some of these lesions. METHODS The setting was a large general hospital in rural New Zealand. The FNAs were performed by a pathologist, or a radiologist for image guided localisations. Material for immunoflow cytometry was collected into RPMI and, when required, material for a cell block was collected into formalin. RESULTS Of the 73 samples collected by FNA nine were inadequate. Light chain restriction could be demonstrated in most FNA samples from B cell lymphomas (28 of 30 adequate samples). The exceptions were two cases of T cell rich B cell lymphoma. Artefactual light chain restriction was seen occasionally in T cell lymphomas, presumably as a result of autoantibodies binding to the cell surfaces. It was possible to subtype most (18 of 30 adequate samples) B cell lymphomas as chronic lymphocytic leukaemia (CLL), follicle centre cell lymphoma (FCCL), or mantle cell lymphoma. The CD4 to CD8 ratio was not usually restricted in T cell lymphomas and coexpression of CD4 and CD8 was not usually found. Loss of pan-T cell antigens was seen in some T cell lymphomas. Four of the six T cell lymphomas and three of the four non-lymphoid malignacies were diagnosed with the aid of cell block immunohistochemistry. Only one of the four cases of Hodgkin's lymphoma showed Reed-Sternberg cells in the FNA smears. CONCLUSIONS It is not always possible to characterise lymphomas as fully with FNA and immunoflow cytometry as is possible with biopsy histology and a full battery of modern investigations. Nevertheless, in the setting of a large rural general hospital immunoflow cytometry on FNA samples is a highly effective method of diagnosing and typing B cell lymphomas. Immunoflow cytometry is of little use for T cell lymphomas or Hodgkin's lymphomas. We advocate the use of cell block immunohistochemistry in preference to immunoflow cytometry for cases in which the cytological appearance of the specimen is overtly malignant but the differential diagnosis includes non-lymphoid malignancy.
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Affiliation(s)
- F Mayall
- Department of Pathology, Waikato Hospital, Hamilton, New Zealand.
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Abstract
This study is a review of the quality of FNA cytology results for breast lesions approximately 18 months before and 10 months after a change from a rapid diagnosis FNA service with consultant pathologist aspirators to a conventional FNA service with clinician aspirators of varied experience. The setting was symptomatic breast clinic in a large hospital in rural New Zealand acting as a tertiary referral centre for a population of 550,000. The results were collected retrospectively and prospectively. The quality of results for pathologist aspirators (total 810) and clinician aspirators (total 403) was compared using the definitions of the NHS Breast Screening Program Guidelines for Cytology Procedures and Reporting in Breast Cancer Screening. There were statistically significant differences in specificity (biopsy cases only) with 73% for pathologists and 49% for clinicians, specificity (full) with 74% and 56%, inadequate rate with 23% and 37%, and complete sensitivity with 76% and 67%. The use of pathologist aspirators allowed the specimens to be reported in a few minutes. Specimens taken by clinicians took at least 30 min to report. The financial aspects of the two approaches are discussed. When compared with clinician aspirators, pathologist aspirators obtained better quality results and these were reported more quickly.
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Affiliation(s)
- M Dray
- Department of Pathology, Waikato Hospital, Hamilton, New Zealand.
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Hennequin C, Tredaniel J, Chevret S, Durdux C, Dray M, Manoux D, Perret M, Bonnaud G, Homasson JP, Chotin G, Hirsch A, Maylin C. Predictive factors for late toxicity after endobronchial brachytherapy: a multivariate analysis. Int J Radiat Oncol Biol Phys 1998; 42:21-7. [PMID: 9747815 DOI: 10.1016/s0360-3016(98)00032-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the predictive factors associated with hemoptysis and radiation bronchitis after endobronchial brachytherapy by univariate and multivariate analyses METHODS AND MATERIALS One hundred forty-nine patients underwent endobronchial brachytherapy and were divided into three therapeutic groups: group 1: patients treated with palliative intent (n=47); group 2: patients treated with curative intent (small endobronchial tumors without mediastinal or general dissemination: n=73); group 3: patients also receiving external irradiation (n=29). One hundred twelve patients had previously received external irradiation. Brachytherapy was delivered with a dose per fraction ranging from 4 to 7 Gy and a prescription point between 0.5 and 1.5 cm, usually 1 cm from the source center. Two to six fractions were delivered according to the therapeutic group and clinical situation. The influence of the following variables on the incidence of hemoptysis or radiation bronchitis was studied: age, sex, Karnofsky score, therapeutic group, histologic type, endoscopic tumor length, dose per fraction, total brachytherapy dose, total external beam irradiation dose, total dose (brachytherapy dose plus external irradiation dose), volumes of the 100% and 200% isodoses, and volumes of the 7 and 14 Gy isodoses. RESULTS We observed 11 hemoptyses (7.4%), 10 were lethal. All but one occurred in patients with progressive disease. Two clinical factors were significantly associated with hemoptysis by univariate analysis: palliative group (p=0.009) and endobronchial tumor length (p=0.004). No technical factors seem to be implicated in the occurrence of hemoptysis. Only endobronchial tumor length remained in the multivariate model (p=0.02). Radiation bronchitis was observed in 13 cases (8.7%). By univariate analysis, a good Karnofsky score (p=0.02), curative treatment (p=0.02), and tumor location on trachea and main stem bronchus (p=0.002) were significantly associated with this complication. Two technical factors were also incriminated: the total dose (p=0.04) and the 100% isodose volume (p=0.02). By multivariate analysis, only the tumor location retained statistical significance (p=0.009). CONCLUSION Hemoptysis is most likely due to disease progression, with the bleeding being facilitated by brachytherapy. Some rare cases could be a direct complication of brachytherapy itself, particularly when tumors are located in the upper lobes. In contrast, radiation bronchitis occurred more frequently in patients with controlled disease, and was significantly influenced by tumor location and technical factors (dose and volumes treated). Technical improvements should increase the therapeutic ratio.
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Affiliation(s)
- C Hennequin
- Service de Cancérologie-Radiothérapie, Höpital Saint-Louis, Paris, France
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Hennequin C, Trédaniel J, Durdux C, Zalcman G, Dray M, Manoux D, Perret M, Housset M, Hirsch A, Maylin C. [Endobronchial brachytherapy: the Saint-Louis Hospital experience]. Cancer Radiother 1997; 1:159-64. [PMID: 9273188 DOI: 10.1016/s1278-3218(97)83534-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE During the evolution of lung cancer, bronchial obstruction is often noticed and is sometimes responsible for serious symptoms. Several methods of desobstruction can be proposed, including brachytherapy. MATERIALS AND METHODS One hundred forty-nine patients presenting with endobronchial brachytherapy were included into the study. Seventy-three were treated with curative intent, 47 with palliative intent and 29 with a combination of external irradiation and brachytherapy. We usually delivered a series of two 7-Gy fractions (1 cm from the catheter), the treatment being repeated one, two or three times. RESULTS When all symptoms were taken into account, respiratory function improvement was present in 79% of the patients. Among the 132 tumors that could be evaluated via a new endoscopy 2 months after treatment, 64 (48.5%) were in complete histological remission. The median survival was 14.4 months for the patients treated with curative intent. Eleven massive hemoptysies and 13 radiation bronchitis were observed. CONCLUSION These results confirm the feasibility and good results related to endobronchial brachytherapy, though controlled studies are needed to better define its place in the therapeutic strategy of bronchial carcinomas.
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Affiliation(s)
- C Hennequin
- Service de cancérologie-radiothérapie, Hôpital Saint-Louis, Paris, France
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Hennequin C, Tredaniel J, Durdux C, Dray M, Manoux D, Perret M, Homasson J, Housset M, Maylin C. 1050 Endobronchial brachytherapy could be curative. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96298-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Griem K, Murthy A, Vannetzel JM, Kies M, Mittal B, Showel J, Rebischung JL, Coupez D, Colin P, Dray M, Blendowski C, Taylor S. 104 The five year results of a randomized trial of sequential versus concomitant cisplatin and fluorouracil and radiation in advanced head and neck cancer. Int J Radiat Oncol Biol Phys 1995. [DOI: 10.1016/0360-3016(95)97769-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Taylor SG, Murthy AK, Vannetzel JM, Colin P, Dray M, Caldarelli DD, Shott S, Vokes E, Showel JL, Hutchinson JC. Randomized comparison of neoadjuvant cisplatin and fluorouracil infusion followed by radiation versus concomitant treatment in advanced head and neck cancer. J Clin Oncol 1994; 12:385-95. [PMID: 8113846 DOI: 10.1200/jco.1994.12.2.385] [Citation(s) in RCA: 148] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To compare two published schedules of cisplatin plus fluorouracil (5-FU) infusion and radiation as either sequential or concomitant treatment for toxicity and efficacy in patients with unresectable head and neck cancer. PATIENTS AND METHODS This was a randomized trial between cisplatin 100 mg/m2 over 15 minutes on day 1 plus 5-FU 1.0 g/m2 by continuous infusion on days 1 to 5, repeated every 3 weeks for three cycles, followed by 70 Gy of radiation in 7 to 8 weeks, versus cisplatin 60 mg/m2 over 15 minutes on day 1 plus 5-FU 800 mg/m2 by continuous infusion on days 1 to 5 plus radiation 2 Gy on days 1 to 5, repeated every other week for seven cycles. Unresectable head and neck squamous cancer patients not previously treated with radiation or chemotherapy and with a performance status of 0 to 2 were stratified by tumor (T) and node (N) groupings and performance status and randomized. RESULTS Two hundred fifteen patients were entered and 214 analyzed, 107 on each arm. After all treatment, overall response rates were different (P = .003), with similar complete response rates, but more partial responses and fewer patients with no change or progression with concomitant treatment. Cox regression analysis for progression-free survival identified concomitant treatment (P = .003), Radiation Therapy Oncology Group (RTOG) stage III grouping (P < .0001), performance status (P = .0002), concomitant treatment (P = .003), and treating institution (P = .006) as significant. The sequential and concomitant treatments showed similar distant failure patterns (10% and 7%, respectively), but divergent regional failure rates (55% and 39%). Severe and worse toxic events were similar between the treatment programs, but radiation-induced mucositis combined with cisplatin-induced water-losing nephropathy, in the concomitant arm only, demanded more supportive care. Survival duration was similar between the treatment arms, but significantly more patients in the sequential arm died of their cancer (P = .011). CONCLUSION Concomitant treatment offered improved disease control, predominantly of regional disease, but benefit was dependent on the experience of the treating institution. Translation of this benefit into improved survival is not yet evident, with an excess of deaths from other causes in the concomitant arm.
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Affiliation(s)
- S G Taylor
- Department of Preventative Medicine, Rush University, Chicago, IL
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Griem K, Murthy A, Showel J, Hartsell W, Kies M, Mittal B, bannetzel J, Rebischung J, Pauchet P, Dray M, Taylor S. Organ preservation in adbanced head and neck cancer: Results of a multi-institutional trial of simultaneous radiation therapy (RT) and chemotherapy (CT). Int J Radiat Oncol Biol Phys 1991. [DOI: 10.1016/0360-3016(91)90632-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dray M, Ferme C, Rain JD, Gisselbrecht C, Flandrin G. [Complete remission of a localized Burkitt-type lymphoma occurring after Hodgkin's disease]. Presse Med 1985; 14:2062-3. [PMID: 2934701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Breau JL, Carcone B, Charpentier F, Dray M, Israël L. [Unexpected infectious syndromes with severe leukopenia during anticancer chemotherapy. Results of antibiotic treatment "on demand"]. Nouv Presse Med 1980; 9:3272. [PMID: 7454573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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