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Primary insulin-like growth factor-I (IGF-I) deficiency is a synonym of growth hormone (GH) insensitivity (GHI), however the necessity of direct confirmation of GH resistance by IGF-I generation test (IGF-GT) is discussed. GHI may disturb intrauterine growth, nevertheless short children born small for gestational age (SGA) are treated with GH. We tested the hypothesis that children with appropriate birth size (AGA), height standard deviation score (SDS) &lt, &minus, 3.0, GH peak in stimulation tests (stimGH) &ge, 10.0 &micro, g/L, IGF-I &lt, 2.5 centile, and excluded GHI may benefit during GH therapy. The analysis comprised 21 AGA children compared with 6 SGA and 20 GH-deficient ones, with height SDS and IGF-I as in the studied group. All patients were treated with GH up to final height (FH). Height velocity, IGF-I, and IGF binding protein-3 (IGFBP-3) concentrations before and during first year of treatment were assessed. Effectiveness of therapy was better in GHD than in IGF-I deficiency (IGFD), with no significant difference between SGA and AGA groups. All but two AGA children responded well to GH. Pretreatment IGF-I and increase of height velocity (HV) during therapy but not the result of IGFGT correlated with FH. As most AGA children with apparent severe IGFD benefit during GH therapy, direct confirmation of GHI seems necessary to diagnose true primary IGFD in them.

Background The objectives of this study were to identify a subgroup of patients with putative primary dermal melanoma after thorough multidisciplinary clinical and histological evaluation, and to describe the clinical, histological and selected molecular features of these lesions. Methods The records of the Western Australian Melanoma Advisory Service were searched for potential cases of primary dermal melanoma. The clinical and histological features were reviewed, immunohistochemical assessment was performed and clinical outcomes recorded. Results Eighteen cases of putative primary dermal melanoma with available clinical data were identified. Two of 12 cases in which further histological sections could be obtained were excluded because of the presence of findings suggesting an epidermal origin on these further sections. In one additional case, such origin could not be histologically excluded. Median follow-up period for the remaining cases was 68 months. Confirmed primary dermal melanoma accounts for 0.87% of cases of melanoma referred to a subspecialist melanoma advisory service. These cases show significant histological overlap with dermal/subcutaneous metastases of melanoma, but display a relatively good prognosis, with a 5-year survival of 87.5%. Conclusion Our results support the recognition of a distinct group of melanoma that mimics metastatic melanoma, but is associated with a relatively favourable outcome. The group of putative primary dermal melanoma is likely to be heterogenous, including cases of primary nodular melanoma in which epidermal connection has not been identified, metastatic melanoma with an occult primary lesion and true primary dermal melanoma.

Aim Ovarian cancer is a common cause of death in women worldwide. The purpose of this article was to report a case series and draw physicians’ attention to the benefits of histpathologic techniques in determining uncommon metastatic diseases. Methods In this study, we report a case series of axillary involvement of ovarian cancer in 6 patients. The data were collected between 2006 and 2015 by analyzing patient's characteristics, and biochemical and immunohistochemical features. No pathologic lesions were detected in breasts. Specific immunohistochemical methods such as GCDFP-15, CA12-5, WT-1, and PAX-8 supported evidence of metastasis from ovarian cancer to axillary lymph nodes. Results Biochemical tests showed increased levels of CA12-5 in all patients. In 5 patients, GCDFP-15 was negative and WT-1 was positive with specific immunohistochemical staining. PAX-8 was positive in 3 of 5 patients. Conclusions Physicians need to be aware that histopathologic and immunohistochemical results can make a significant contribution in determining the true primary tissue of metastatic adenocarcinoma, even in the absence of typical clinical findings.

O A. sintetiza a Exortação Apostólica Pós-Sinodal Verbum Domini, realçando sua estrutura dialógica e chamando a atenção para o que considera os pontos fortes do documento: a continuidade entre a Verbum Domini e a Dei Verbum (do Vat. II) no que concerne à centralidade da Palavra de Deus (Cristo); esta, como sendo o miolo do documento, não a Bíblia, embora esta seja seu receptáculo; uma renovada comunhão entre exegese, teologia e pastoral; Maria, ponto de referência para se compreender a relação entre Palavra de Deus e Igreja; leitura orante e lectio divina como abordagens que favorecem o encontro pessoal e comunitário com a Palavra; a dimensão inerentemente missionária da Palavra de Deus, que se dá, sobretudo, pelo testemunho de vida; o impulso ao diálogo ecumênico e inter-religioso decorrente do encontro com a Palavra; a comunhão e a alegria, resultantes desse encontro; o estilo sapiencial do texto e sua linguagem viva, calorosa e comunicativa, fruto da experiência de encontro com o Verbo encarnado, Palavra de Deus. Neste quadro, a Bíblia é vista como verdadeiro código primordial da humanidade, capaz de falar a uma sociedade plural, desejosa, em tempos de árido relativismo, do Evangelho da Vida.Abstract: The Author summarizes the Post-Synod Verbum Domini Apostolic Exhortation, emphasizing its dialogical structure and calling attention to what he considers to be the strong points of the document: the continuity between the Verbum Domini and the Dei Verbum (of the Vatican II) with regard to the centrality of God’s Word (Christ’s); considering the latter – rather than the Bible that would be just its receptacle – as the kernel of the document; a renewed communion between exegesis, theology and pastoral; Maria as a point of reference in order to understand the relationship between God’s Word and the Church; praying-reading and lectio divina as the types of approaches that encourage the individual and the community encounter with the Word; the inherently missionary dimension of God’s Word, that happens, above all, by the testimony of life; the impulse towards the ecumenical and inter-religious dialogue resulting from the meeting with the Word; the communion and the joy resulting from this meeting; the sapiential style of the text and its lively, warm and communicative language, fruit of the experience of the meetingwith the incarnated Word, God’s Word. In this picture, the Bible is seen as mankind’s true primary code able to speak to a plural and yearning society, at a time of arid relativism of the Gospel of Life.

Luning., K. G., Lake, S. and Linde, M. 1984. Genetics of inbred Drosophila melanogaster XII. Effects of an X-chromosome inversion on primary and secondary non-disjunction.—-Hereditas 100: 247–257. Lund, Sweden. ISSN 0018–0661. Received August 1, 1983 In an inbred line of Drosophila melanogaster. Oregon (code 2), an inversion covering the proximal half of the X-chromosome was induced (symbol: In(l) Lu-l y wd cxvf-2). It has been shown that inversion homozygotes have low frequencies of primary nun-disjunction. in the same manner as equilinear females with regular gene order of the 2–line. Intra-strain structural heterozygotes gave an excess of XO exceptionals but also a 5–fold increase of true primary non-disjunction (XXY) as compared to structural hornozygotes. Inter-strain crosses with mothers from line “K” revealed an influence both by the maternal genome and by the origin of the cytoplasm. Tests of secondary non-disjunction in structural heterozygous XXY females from both intra- and inter-strain crosses indicated highly complicated relations. When the mothers were of “2” origin the first brood showed lower frequencies of XXY exceptionals than in successive broods. whereas when the mother was of “K” origin there was a decrease after the 3rd brood (7th day). The “K”-line showed a dominance effect which was manifested by higher frequencies of XXY exceptionals. In regular daughters the Y-chromosome followed preferentially the proximal part of the X-chromosome of “K”. origin. There was no preference in the Y-chromosome distribution in intra-strain hybrids. There was a pronounced low frequency of recombinants among exceptionals. This indicates that the high frequencies of exceptionals from inversion heterozygous XXY females occur by another mechanism than in equilinear XXY females with the same genetic background.

Interest in primary prevention in mental health has varied depending on the socio-economic, cultural and political climate. True primary prevention looks at the institutional and social structure that fosters growth, promotes adequate development, and optimises mastery as well as identifying and assisting those at high risk. Current ideological forces either ignore or add confusion to that highly complex area. The history of the changes in the paediatric hospitalisation of young children over the last three decades, which originated in the United Kingdom and has covered the globe, serves as a model for looking at what primary prevention can do and its significance for the field of mental health.

We report a case of nontraumatic, spontaneous venous aneurysm of the left axillary vein. This case may represent only the second such case ever reported in the English-language medical literature. Venous aneurysms are often associated with trauma, arteriovenous fistula, or other venous abnormal hemodynamic conditions, but true primary venous aneurysms are very rare. Surgical excision was uncomplicated and performed easily.

Malignant melanoma involving the respiratory tract is nearly always metastatic. True primary tumors are very rare, and only approximately 28 cases have been reported in the literature. Extensive clinical and histopathological examinations are needed to ascertain that the lung is the primary site. We present the case of a 67-year-old man with an apparent primary malignant melanoma of the lung in the right lower lobe. We also review the literature.

Sarcoidosis is a systemic disease of unknown cause resulting in the development of non-caseating granulomas that can affect all organs of the body, but with predominant pulmonary involvement. Pulmonary sarcoidosis has a wide variety of radiographic features. The most common computed tomography (CT) feature of pulmonary sarcoidosis is irregularly-thickened bronchovascular bundles that pathologically present as the presence of peribronchial granulomas.1 However, cavitary pulmonary lesions are uncommon, and in particular, true primary cavitary sarcoidosis extremely rare.2e4 In this report, we present a case of a primary cavitary sarcoidosis with “lotus seed-like” manifestations.

True primary cervical pregnancies are rare. Although these can cause massive hemorrhage, most of these abort during the first trimester without having been diagnosed. However, cervico-isthmic and cervico-isthmic corporeal pregnancies are more likely to persist to an advanced gestation in the second and third trimester and cause profuse bleeding with attempted removal of the placenta.A case of cervico-isthmic corporeal pregnancy at term with near exsanguinating hemorrhage is reported. A 35-year-old Sri Lankan woman presented for prenatal care with the complaint of daily, painless vaginal bleeding. An ultrasound showed a cervical pregnancy. Despite counseling regarding the poor outcome of cervical pregnancies, the patient wished to continue the pregnancy. At repeat cesarean section, bleeding was profuse requiring pressure, electrocautery, and oversewing the uterus. The patient developed massive bleeding in the recovery room, requiring laparotomy, and total abdominal hysterectomy to control bleeding. She received multiple blood transfusions and required re-exploration for recurrent hemorrhage. The pathology report revealed a placenta accreta and chorionic villi at the junction of the isthmus and cervix. After a long hospital course, the patient was discharged.Cervical pregnancies involving the isthmus and isthmus and corpus are more common than true cervical pregnancies. They are significant because placental involvement of the cervix can cause erosion of the uterine arteries and massive bleeding when placental removal is attempted. Anticipatory planning, including permission for hysterectomy if necessary, may lead to improved maternal and fetal morbidity.ObstetriciansGynecologists, Family Physicians.After completion of this article, the reader should be able to distinguish the different types of cervical pregnancies, describe management strategies for cervical pregnancies, and summarize the diagnostic criteria for cervical pregnancies.

A study was undertaken to analyze seton fistulotomy with counter drainage as a treatment modality for horseshoe abscess fistula. In a previous report of 27 patients with partial or complete horseshoe abscess fistula, 24 patients underwent primary fistulotomy and counter drainage with a recurrence rate of 28.6 percent. Two patients were treated by seton fistulotomy and counter drainage with no recurrence. Therefore, nine additional patients underwent this procedure. Recurrent horseshoe abscess fistula occurred in 2 of 11 patients (18.1 percent). Seton fistulotomy with counter drainage has become the authors' operative procedure of choice for horseshoe abscess fistula. This method may prove more effective if the true primary abscess cavity is identified, the seton is removed appropriately, and postoperative care of the cavity is adequate. Method of management is discussed.

Objectives Eye injuries are relatively common following detonations. The majority of these are caused by secondary fragments. Primary blast injury to the eye (from the air-blast alone) has been described historically, but the differentiation of air-blast and fragment aetiologies in the reports is not clear. The aim of this review is to consider the evidence in the literature for true primary blast injury to the eye. Methods A literature review using Medline, Pub-med and Web of Knowledge databases. Conclusions Overall, there is little conclusive evidence that primary ocular blast injury occurs in survivors of explosions. However, some case reports do surmise its occurrence and it cannot be unequivocally ruled out. If it does occur, it is more likely to be at high overpressures that will produce life-threatening injuries. The development of enhanced blast weapons may result in an increased incidence. At present however, the most severe and damaging threat to the eyes from blast remains the impact of fragments and debris.

Context.—Primary bladder angiosarcomas are extremely rare, and their clinical and pathologic features are not well described. Objective.—To further refine the clinical features of primary bladder angiosarcomas and define their pathologic spectra. Data Sources.—Relevant sources were identified using MEDLINE and a subsequent bibliographic search of all pertinent reports and reviews. We also searched the M. D. Anderson pathology archives. Study Selection.—After excluding 4 cases that likely secondarily involved the bladder, we identified 9 true primary bladder angiosarcomas. Data Extraction.—Data were extracted on the following: demographics, clinical presentation, predisposing factors, gross pathology, microscopic pathology, immunophenotype, therapy, and outcomes. Data Synthesis.—Primary bladder angiosarcomas were found at a mean age of 64.2 years, with a male-female ratio of 8:1. Two cases arose in a postirradiation setting. Primary bladder angiosarcomas typically presented with hematuria and were grossly hemorrhagic, raised masses (mean size, 6.7 cm) of the trigone and/or dome. Histologically, most showed classic anastomosing channels lined by plump hyperchromatic cells, though many showed variant histology such as solid growth and epithelioid cytology. Three (43%) of 7 patients died within a year, but only 1 patient died with evidence of disease. The remaining patients were alive at the time of publication of their respective cases (mean, 22 months). Conclusions.—Primary angiosarcomas of the bladder are typically rare tumors of middle-aged and elderly men that present with locally advanced disease and show a wide histologic spectrum. However, their prognosis may be better than previously thought.

Urethral calculi could be either classified as either primary or secondary calculi based on their origin. Primary calculi form in the urethra, whereas secondary calculi have their origin elsewhere in the urinary tract.1 True primary calculi are rare and they mostly form in prostatic and membranous …

True primary venous aneurysms are rare. This is the first report of such an aneurysm involving the lesser saphenous vein. Though most often a medical curiosity, such lesions can result in serious morbidity and even mortality. Because of their rarity they are often misdiagnosed. Salient features pertaining to classification, diagnosis, and treatment are reviewed.

Twenty-five patients with primary genital herpes were treated in a double-blind placebo-controlled randomized trial of intravenous acyclovir. Thirteen patients received the drug and 12 a placebo. Three in each group were male. In the acyclovir group 10 patients had true primary herpes compared with six in the control group. The median time to healing of all lesions was significantly decreased from 11 to seven days (p less than 0.05), and the median duration of viral shedding from all lesions was decreased from eight to two days (p less than 0.001). The time to cessation of new lesions was decreased from a median of two days to zero days (p less than 0.001). Intravenous acyclovir is an effective treatment in decreasing the length and severity of primary genital herpes.

The efficacy of a delayed release preparation of metformin (‘Obin’)† has been evaluated in 60 diabetic patients either obese and uncontrolled by diet alone or true primary or secondary failures to sulphonylurea treatment. The results show no difference in the therapeutic response between single and twice daily administration of ‘Obin’; likewise there was no difference in frequency of side-effects.

In cases of true primary carcinoma of the lung surgery as yet offers little hope of relief. No completed group of cases of this disease treated by irradiation has been reported, and among the cases reported singly there are no authentic cures. A group of nineteen patients treated by high-voltage roentgen rays is reported. All died within ten months, all but three within four months. This brief period of survival is the same as that in a group of cases in which there was no treatment. In spite of the fact that life is not prolonged, roentgen-ray treatment in all but advanced cases gives marked temporary palliation.

One of the principal functions of the SS Hope is medical teaching at all levels of physician development. In the senior group this takes the form of a mature international exchange to the mutual benefit of both visiting and host participants. At less developed levels, it becomes not so much a matter of imparting information as the demonstration of attitudes, habits, and principles basic to good all-round patient care and community concern. Advanced techniques are demonstrated as ultimate goals for development, but practical application of medical knowledge to the socioeconomic conditions of the host country is the true primary objective.