North American Journal of Medicine and Science
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Squamous Cell Carcinoma of Lung Metastatic to a Mediastinal Lymph Node Involved by Chronic Lymphocytic Leukaemia /Small Lymphocytic Lymphoma, A Case Report with Review of Literature
No full textMetastasis of a cancer to another coexisting tumor is a very rare event. When this occurs, it confers a diagnostic dilemma. So far, only very few cases have been reported regarding primary squamous cell carcinoma metastatic to lymph nodes replaced by chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL), most of which were metastasis from primary skin cancers. Here we present a rare case of squamous cell carcinoma of lung metastatic to CLL/SLL-involved mediastinal lymph node. The patient was an 82-year-old male who had a history of CLL/SLL and recurrent stroke. His disease has been stable with a white cell count maintained around 60,000 for the previous 3 years without medication. He presented with left-sided facial droop, confusion and slurred speech with a white cell count of 110,000. CT Scan performed recently showed a 2.6 cm right lung mass with enlarged bilateral hilar and mediastinal lymph nodes. Mediastinal lymph node biopsy was performed and sent for frozen section. Frozen section was misinterpreted as “negative” due to diagnostic difficulty. On permanent sections, aggregates of cohesive epithelioid cells (Figure 1) were found in a background of homogenous population of small lymphocytes. The normal architecture of lymph node was effaced (Figure 5). The epithelioid cells showed increased nuclear/cytoplasm ratio, clumpy chromatin, and were positive for CK5/6 (Figure 2) and negative for BerEp4, Mucicarmine (Figure 2) and TTF-1 (Figure 1). The small lymphocytes in the background were positive for CD5, CD20 and CD23 (Figure 6-8), and negative for CD3. These morphological and immunohistochemical features are diagnostic for poorly differentiated squamous cell carcinoma metastatic to a lymph node involved by CLL/SLL. We compared this case with other similar cases available in the literature and discussed diagnostic pitfalls in such situation.
Childhood Obesity in Minority Populations in the United States
Get PDFObesity became a public health crisis in the United States, which affects both adults and children.1,2,24,25 Approximately 31% of U.S. children and adolescents aged 2-19 years were overweight or obese, and almost 17% were obese in 1999-2004.3-5,24 Studies suggest that increased consumption of more energy-dense, nutrient-poor foods with high levels of sugar and saturated fats, combined with reduced physical activity, have contributed to the rising obesity epidemic among children.6,21,28 Childhood obesity increased the risk of many diet-related chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension, stroke, and certain forms of cancers.7 It is important to prevent or control the epidemic across all racial/ethnic groups. However, minority children have a higher prevalence rate of obesity than non-Hispanic white children. This current paper reviews the trends and factors that may contribute to the racial/ethnic disparity
Clinical Usefulness of High-Sensitivity C-Reactive Protein in Predicting Risk of the Metabolic Syndrome: Epidemiologic Evidence
Get PDFC-reactive protein (CRP) is an acute-phase protein, which is primarily synthesized in the liver. In response to most forms of inflammation, infection, and tissue damage, plasma levels of CRP in human body may rise rapidly and markedly, as much as 100 or 1000-fold or more during the acute phase. In epidemiological studies, CRP levels well below the conventional clinical upper limit of 10 mg/L (as measured by high sensitivity CRP) have consistently been predictive of cardiovascular disease1,2 and type 2 diabetes in various populations.3 The “high sensitivity” refers to the lower detection limit of the assay procedures being used than previous commercial assays routinely used for clinical measurements.4 Highly sensitive assays for CRP are widely used in epidemiologic studies to precisely measure values within the range less than 10 mg/L. High-sensitivity CRP thus has become a clinically useful marker oflow-grade chronic inflammation. Low-grade chronic inflammation may be one of the common antecedents underlying the clustering of obesity, impaired glucose tolerance, dyslipidemia, and hypertension, known as the metabolic syndrome. Ranges of <1, 1 to 3, and >3 mg/L, which correspond to approximate tertiles of the CRP distribution in healthy US adults, are used to denote low-, moderate-, and high-risk cardiovascular groups. Of note, CVD and type 2 diabetes are the major sequelae of the metabolic syndrome. CRP independently predicts both CVD and type 2 diabetes, but it is unknown whether CRP evaluation is a valuable addition to the metabolic syndrome for risk assessment of CVD and diabetes
Insufficient Evidence for the Efficacy of Homocysteine- Lowering Treatment on Cardiovascular Disease: The Homocysteine Hypothesis Revisited
Get PDFA large body of observational studies has suggested that a moderate increaseof plasma total homocysteine (tHcy) concentration is a modest risk factor for CHDand a somewhat stronger risk factor for stroke, at least innonfortified populations. Folic acid and vitamin B6 and B12 supplementation can lower tHcy levels. However,recent clinical trials in populations at high risk for CVD havefailed to show treatment benefits with homocysteine-lowering dietary interventions. There is continued controversy with regard to whether high homocysteine level is a cause of CVD and whether homocysteine-lowering therapy can protect against the development of CVD
Medical Management of Adult Obesity
Get PDFObesity has become a major public health problem. More than 300 million adults are affected world wide, and among them 20% are Americans (1). Obesity causes over 300,000 deaths yearly, making it the second most common cause of preventable death in the United Sates (2). Currently nearly two thirds of Americans are overweight and half of them are obese, the number of which has doubled since 1980. The prevalence of overweight and obesity among American children and adolescents (age 6 – 19 years) has tripled since 1963. On average, American adults are one inch taller and 25 lbs heavier today than they were in 1960. How did we become so fat
A Forty-One Year Old Man Died of Hepatocellular Carcinoma from Hepatitis B
Get PDFHepatocellular carcinoma (HCC) is a primary liver malignancy, the global incidence is about 15 cases per incidence of HCC 137,000 new cases.1 The most important risk factor is viral hepatitis, especially hepatitis B.2-3 Among Chinese population, 15-20% is described as HBV carriers (hepatitis B surface antigen positive). The relative risk of HCC among Hepatitis B carriers is 223 times that of non-carriers. These chronic carriers are usually not symptomatic and have normal liver function. Despite this, they are at risk of developing Hepatocellular carcinoma without signs of cirrhosis, active or advanced hepatitis. Unfortunately, the diagnosis is usually late4-5 and the prognosis is generally poor, as the case described above
Gene-Diet Interaction: DNA Repair Gene, Folate Status and Breast Cancer Risk
Get PDFFolate levels have been inversely associated with breast cancer risk. Because folate deficiency can cause DNA damage such as uracil misincorporation, single-strand breaks, and double-strand breaks, genetic polymorphisms in base excision repair and double-strand break repair genes may lead to variation in DNA repair proficiency and modify the effect of folate on breast cancer risk. We present two examples of interaction between plasma folate levels and DNA repair genetic variants in a nested case-control study within the Nurses’ Health Study (712 case-control pairs). Compared with the reference group of non-carriers in the lowest quartile of plasma folate, the reduction in risk (66%) was statistically significant among XRCC1 194Trp carriers in the highest quartile (multivariate odds ratio, 0.34; 95% confidence interval, 0.16–0.72). The inverse association between XRCC1 194Trp and breast cancer risk was attenuated by lower plasma folate status. The inverse association between plasma folate level and breast cancer risk was stronger among 194Trp carriers (P, trend = 0.01) than non-carriers (P, trend = 0.09). We also observed that the positive association between the XRCC2 188His allele and breast cancer risk was significant only in women in the lowest plasma folate quartile (carriers versus non-carriers; multivariate odds ratio, 2.04; 95% confidence interval, 1.05–3.97), and this excess risk was abolished among those with higher plasma folate levels. Moreover, the inverse association between plasma folate level and breast cancer risk was stronger among XRCC2 188His carriers (P, trend = 0.004) than non-carriers (P, trend = 0.09). Although none of the statistical tests for interaction was significant, these data give some support to the hypothesis that genetic variations in DNA repair genes modify the relation between plasma folate level and breast cancer risk
Retinal Prosthesis: An Innovative Technology for Treating Blindness
Get PDFDiseases of the retina, such as retinitis pigmentosa (RP) and age-related macular degeneration (AMD), are major causes of blindness in the industrialized world. There are 25 million people across the globe, including 6 million in the United Statesalone, or who are severely visually impaired, due to RP and AMD. By 2020, this figure is expected to double, creating a virtual vision-loss epidemic. 1Photoreceptors degenerate in both diseases, however, ganglion cells and other neurons remain functional in these patients. Currently, very few treatments are available for both diseases. Many studies to treat these diseases are performed, which include gene therapy, transplantation of stem cells, neurotrophic factors, and retinal prosthesis
The Biomedical Aspects of Autism
Get PDFOver the last several decades, autism has become an increasingly prevalent developmental disorder that has received attention both in the medical and public communities. In the 1960’s, the incidence was 1/10,000 which has since increased to 1/150 from 1991 to 1997. In 2007, more children were diagnosed with autism compared with diseases like cancer, diabetes, and AIDS combined. On average a new case of Autism is diagnosed every 20 minutes in the USA.1 Autism costs more than $90 billion a year nationwide, however, the research grant available for autism accounts only to 0.3% of the total NIH funding, which is still lower than what is available for other less common disorders. Autism is more of a clinical syndrome than a disease. It is a behaviorally defined disorder.2 It was first described by Leo Kanner in 1943,3 and a milder form was described by a German doctor Hans Aspergers, now known as Asperger Syndrome.4 Since then, many subtypes have been proposed and its cause, diagnosis and treatments remain controversial. This clinical syndrome is characterized by impaired social interaction, qualitative impairment in communication and restrictive, repetitive and stereotypic behaviors
The New World
Get PDFI came to the United States of America almost forty years ago. One of my biggest worries prior to my move was my language proficiency. My American friends at the time reassured me that my English was not a problem. I somehow agreed with them because I was able to understand the conversations and dialogues while viewing American movies. However, my confidence was completely shattered during on my plane ride toAmerica. I was unable to understand the captain’s instructions. The movie was also difficult to understand, sans the Chinese subtitles. In fact, if I had not checked with a fellow passenger sitting beside me, I wouldn’t have known that the plane had already arrived at my final destination:Philadelphia