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Cardiac allograft vasculopathy (CAV) is a leading cause of long-term morbidity and mortality in pediatric heart transplant (HTx) recipients. Exercise stress echocardiography (ESE) has been shown to be useful in the detection of angiographically confirmed coronary artery disease in children. However, the prognostic utility of ESE for prediction of cardiac events in HTx survivors is unknown.We aim to assess whether an abnormal (positive) ESE is be associated with a higher risk of future cardiovascular (CV) outcomes in pediatric HTx recipients.We conducted a retrospective review of CV outcomes in a cohort of 95 pediatric HTx recipients who underwent 188 ESEs over a 10-year period. A composite endpoint for CV events including myocardial infarction, hospitalization for nonrejection heart failure, coronary revascularization, need for repeat transplantation, and death was used. Based on the interpretation of the ESE results, each ESE study was classified for this study as either positive (abnormal) or negative (normal) for ischemia. Results of the coronary angiograms performed near the time of ESE were also assessed and classified for this study as positive (abnormal) or negative (normal) for CAV according to standard HTx criteria for CAV.Fifty-one (27%) ESEs were positive for ischemia. There was a total of 35 CV events in 23 patients. A positive ESE was associated with increased risk of any CV event (hazard ratio = 3.55; 95% CI, 1.52, 8.28), as well as an increased risk of CV death (hazard ratio = 3.19; 95% CI, 1.23, 8.28). Freedom from composite CV outcome at 1, 2, and 3 years following a positive ESE was 89.9% (95% CI = 77.3%, 95.7%), 81.5% (95% CI = 65.9%, 90.5%), and 63.2% (95% CI = 41.9%, 78.5%), respectively. Freedom from composite CV outcome at 1, 2, and 3 years following a negative ESE was 99.3% (94.8, 99.9), 98.4% (93.6, 99.6), and 97.0% (90.6, 99.1), respectively. No patient died within 1 year of a negative ESE.In this largest study of ESE in pediatric HTx recipients, a positive or abnormal ESE is associated with increased future CV morbidity and mortality. Conversely, a negative ESE can help predict CV event-free survival. Even in the setting of a normal coronary angiogram, our pilot data show that an abnormal ESE may still be clinically important. Use of ESE in follow-up may improve risk stratification and management of pediatric HTx recipients.

Professional development in chemistry doctoral programs has traditionally relied on the skills and opportunities embedded within the requirements of the Ph.D. program being sufficient for employment. As a result, little emphasis is usually placed on career planning and exploration within the doctoral curriculum. Additionally, the support provided in finding employment after graduation can vary largely depending on individual advisors, departments, and university resources. Although the resources provided by individual departments for chemistry doctoral students may appear sufficient, this article discusses the establishment and implementation of a peer-supported professional-development initiative (PSPDI): a nondepartmentally initiated program created by doctoral students for doctoral students to provide opportunities for professional development and career resources. The implementation of a PSPDI and the benefits a peer-supported program are discussed, along with other details that may be relevant for programs looking to implement or enhance existing doctoral professional-development programs.

Bottom-up fabrication of such arrays with specific orientation of nanoparticles remains a challenge. In this paper, we report an immobilized seed-mediated growth strategy for the fabrication of two-dimensional (2D) arrays of mono- and bimetallic polyhedral nanocrystals with well-defined shapes and orientations on a substrate. This method relies on the controlled solution-phase deposition of metals (i.e., Au and Pd) on a selectively exposed surface of self-assembled seed nanoparticles that are immobilized on a substrate through collapsed polymer brushes. By using this approach, we demonstrated the preparation of various 2D arrays of shaped Au nanocrystals and Au core/Pd shell nanocrystals with asymmetric geometry of two halves and controlled orientations with respect to the substrate. The shape evolution of seeds to final nanocrystals was systematically monitored and evaluated by electron microscopic imaging. Our study suggests that the shape and orientation of nanocrystals within arrays is determined by the preferential orientation of assembled seed nanoparticles on the substrate and controllable deposition of metals on exposed crystal facets of immobilized seeds. The synthetic approach we developed presents an important addition to current tools for the fabrication of substrate-supported functional nanostructures.

The oriented attachment of small nanoparticles (NPs) is recognized as an important mechanism involved in the growth of inorganic nanocrystals. However, non-oriented attachment of dissimilar NPs has been rarely observed in dispersion. This communication reports a welding phenomenon occurred directly between as-synthesized dispersions of single-component Au and chalcogenide NPs, which leads to the formation of asymmetric Au-chalcogenide hybrid NPs (HNPs). The welding of dissimilar NPs in dispersion is mainly driven by the ligand desorption-induced conformal contact between NPs and the diffusion of Au into chalcogenide NPs. The welding process can occur between NPs with distinct shapes or different capping agents or in different solvent media. A two-step assembly-welding mechanism is proposed for this process, based on our in situ electron spin resonance measurements and ab initio molecular dynamics simulation. The understanding of NP welding in dispersion may lead to the development of unconventional synthetic tools for the fabrication of hybrid nanostructures with diverse applications., Solution-phase welding of nanoparticles to form larger structures typically requires that the particles are the same type, limiting the diversity of possible products. Here, the authors report a welding process between gold and chalcogenide nanoparticles in dispersion that leads to asymmetric hybrid nanoparticles with two distinct domains.

Encephalitis is inflammation of the brain parenchyma caused by a wide variety of infectious and noninfectious conditions. Anti– N -methyl-D-aspartate receptor (NMDAR) encephalitis is a recently described but increasingly recognized autoimmune disorder characterized by specific clinical features and the presence of anti-NMDAR antibodies in the cerebrospinal fluid (CSF) and serum. These autoantibodies appear to have an important role in the pathogenesis of the disease. This type of encephalitis is more prevalent in young women with ovarian teratomas, although it has also been described in adults and children of both sexes with and without identifiable neoplasms. Inspired by the case of our patient, a 19-year-old African American woman, we present a review of the literature regarding this noninfectious cause of acute encephalitis and discuss its relationship with tertomas. * HSV : herpes simplex virus; VZV : varicella-zoster virus; WNV : West Nile virus; CNS : central nervous system; ADEM : acute disseminated encephalomyelitis; NMDAR : N -methyl-D-aspartate receptor; WBC : white blood cells; MRI : magnetic resonance imaging; CSF : cerebrospinal fluid; PCR : polymerase chain reaction; CDC : Centers for Disease Control; CT : computed tomographic, IgG : immunoglobulin G; FLAIR : fluid-attenuated inversion recovery; EEG : electroencephalographic; IgM : immunoglobulin M; IVIGs : intravenous immunoglobulins

The effect of polymeric additives on molecular gelation was explored using poly(acrylic acid) and pyridine-based gelators. A significant reduction in the critical gel concentration (cgc) and an increase in gel strength were observed when the polymer was present during gel formation. Detailed studies revealed that the polymer is adsorbing onto the growing fibers, reducing the growth rates, and leading to thinner fibers. These and other morphological changes lead to improved gel properties by increasing the number of fiber–fiber entanglements. Several other polymers were briefly examined and these studies revealed that polymer structure is important. The polymer containing a complementary functional group relative to the gelator (e.g., H-bond donor/acceptor) provided the lowest cgc.

The widespread use of highly active antiretroviral therapy (HAART) in HIV-infected individuals has effectively lessened the incidence of AIDS-related malignancies, in particular, Kaposi's sarcoma and non-Hodgkin's lymphoma. However, during the same time period many cancers, not defined as AIDS-related, have been observed to be more prevalent in HIV-positive patients compared with similar cohorts of the general population. Well documented is the observation that, in some profoundly immunosuppressed HIV-infected individuals, there is a paradoxical deterioration in their clinical status shortly after the initiation of HAART. This paradoxical phenomenon is characterized by an intensely pathologic inflammatory reaction which may be directed against a variety of infectious or non-infectious antigens, the consequence of which results in a rapid and deregulated restoration of antigen specific immune responses. This phenomenon, termed the immune reconstitution inflammatory syndrome (IRIS), results in localized inflammation (where disseminated is typical) or in an unusual intensity of the inflammatory response. While the majority of reported IRIS cases are related to underlying infections, in a few reported instances, the development of NHL-associated with immune recovery following the initiation of HAART has also been linked to IRIS. We describe a case of Burkitt's leukemia/lymphoma which developed in a young man with AIDS less than 3 months after HAART was initiated. A propos this case, we review the literature on IRIS associated lymphomas and other malignancies in HIV/AIDS patients and discuss the proposed theoretical explanations.

The identification of latent tuberculosis infection (LTBI) in any individual or population has proven to carry significant importance not only for that person’s health, but also for the control and eventual elimination of tuberculosis (TB) in the United States. Traditionally, the tuberculin skin test (TST) has served as the standard of care for the identification of prior exposure to Mycobacterium tuberculosis (MTB). However, the specificity of a positive test is less than optimal. It is either due to previous vaccination intended to prevent TB or infection with nontuberculous mycobacterium (NTM). Newer tests classified as interferon-gamma release assays (IGRA) possess potential advantages over the TST when used for identifying those with MTB infection. We recently diagnosed a case of pleuropulmonary infection involving an unusual NTM, Mycobacterium interjectum (M. interjectum) , in an immunocompromised man diagnosed 1 year after he had been treated for LTBI based on a reactive TST. A propos this experience, we discuss the beneficial role of IGRAs and review the literature on infection with M. interjectum . * LTBI : latent tuberculosis infection TST : tuberculin skin test MTB : Mycobacterium tuberculosis NTM : nontuberculous mycobacterium IGRA : interferon gamma release assays PPD : purified protein derivative BCG : Bacillus Calmette-Guerin FDA : Food and Drug Administration IFN-γ : interferon-gamma IGRAs : interferon-gamma release assays INH : isoniazid TNF-α : tumor necrosis factor alpha CXR : chest radiograph CT : computerized tomographic AFB : acid-fast bacilli TB : tuberculosis RA : rheumatoid arthritis MTX : methotrexate DMARDs : disease-modifying antirheumatic drugs CDC : Centers for Disease Control and Prevention DTH : delayed-type hypersensitivity QFT : QuantiFERON-TB QFT-G : QuantiFERON-TB Gold QFT-GIT : QuantiFERON-TB Gold In-Tube ELISA : enzyme-linked immunosorbent assay ESAT-6 : early secretory antigenic target-6 CFP-10 : culture filtrate protein-10 ELISpot : enzyme-linked immunospot assay PBMCs : peripheral blood mononuclear cells MOTT : mycobacteria other than tuberculosis

Prosthetic valve endocarditis (PVE) due to mycobacteria is a rare but frequently fatal complication that may occur early after the surgical procedure, or even years later. Infection has been described with both mechanical and biologic valvular prosthesis. The most commonly implicated mycobacterial species belong to the rapid-grower group (M. chelonei, M. fortuitum, and M. abscessus) of nontuberculous mycobacteria (NTM). The source of infection in this context is thought to be nosocomial, likely related to preoperative or intraoperative contamination of the prosthesis by contact with aqueous solutions containing the organisms. These infections are difficult to diagnose because blood cultures are often negative. Clinically, it is important to recognize the possibility of NTM-PVE in the differential diagnosis of culture-negative patients who develop signs and symptoms of endocarditis, whether they present early or late in onset after the surgical procedure. These patients should be treated with surgical removal of the infected valve, followed by adequate antimicrobial therapy based on the susceptibility of the species isolated from the valve or perivalvular tissue culture. In a significant number of patients, however, an unstable hemodynamic condition ensues, precluding surgical intervention, and therefore leading to a high mortality rate.

Infections caused by fungi belonging to the phylum Zygomycota encompass a variety of clinical presentations, the severity and outcome of which depend, in large part, on the immunologic status of the host, as well as the particular fungal species causing the infection. Generally, infections due to Zygomycete fungi of the Mucorales order (ie, Rhizopus, Mucor, Absidia, Cunninghamella, etc) occur in immunocompromised individuals or patients with poorly controlled diabetes mellitus. These characteristically are angioinvasive, frequently disseminate, and have a rapid and often fatal clinical course. Conversely, diseases caused by Zygomycetes of the Entomophthorales order (Conidiobolus and Basidiobolus) most commonly present in immunocompetent hosts, predominantly involve subcutaneous tissue, and typically have a protracted and chronic clinical evolution. Disease caused by the Entomophthorales is most often encountered in tropical areas of the world where the causative fungi have been isolated from both soil and plant detritus. We review the clinical and histopathologic characteristics of chronic subcutaneous zygomycoses apropos of a case recently diagnosed at our institution.

Encephalitis caused by Balamuthia amebic species is an increasingly recognized chronic granulomatous infectious process that may affect both immunocompetent and immunocompromised individuals. The course of the disease is insidious but fatal in most cases, mainly because of delayed diagnosis, difficulty in isolation and/or identification of the organism, and lack of well-established therapeutic regimens. We report a fatal case of Balamuthia mandrillaris chronic granulomatous encephalitis in an immunocompromised host and review the clinicopathologic characteristics of infections caused by this and other pathogenic free-living amebae.

Zoonotic filarial infection by Brugia species is an uncommon occurrence in North America. Several Brugia filarial species have been isolated from wild animal reservoirs, particularly rabbits, raccoons, and bobcats. This nematode requires an insect vector to complete its life cycle and to transmit the infection to a definitive host. In endemic areas, Brugia species cause lymphatic filariasis, manifested as lymphadenopathy, lymphedema, and, in some cases, elephantiasis, a deforming sequela of longstanding lymphatic vessel obstruction. In the United States, less than 30 cases of autochthonous filarial infection have been reported in the literature since originally described in 1962. In a review of our files, we found a case of locally acquired Brugia lymphadenopathy. To our knowledge, this is the second case reported in Florida. This case report serves as a review of the epidemiologic, pathologic, and clinical aspects of this parasitic infection.

Campylobacter species are ubiquitous gramnegative bacteria with a natural reservoir in the digestive tract of wild and domestic animals, particularly avian species (waterfowl and poultry), as well as in non-chlorinated sources of water. Campylobacter jejuni is one of the most common bacterial causes of infectious enterocolitis worldwide, and the leading infectious agent implicated in the pathogenesis of Guillain-Barre Syndrome (GBS). Unsuspected exposure to zoonotic Campylobacter species should be considered as a potential etiology of sporadic GBS in the absence of preceding clinical manifestions of infection, depending on the appropiate enviromental and epidemiologic setting.

The complexity of the anatomy of the sella turcica and its surroundings accounts for the large number of pathologic entities that may involve this critical area. Intrasellar and parasellar schwannomas are exceedingly rare; only a handful of true sellar tumors of this nature have been reported in the English literature. These lesions may simulate nonsecretory pituitary adenomas clinically and neuroradiologically. Although benign, complete surgical resection of these tumors is usually difficult because of their size, invasiveness, and rich vascularity. From the histopathologic stand point, those cases lacking typical schwannoma histomorphologic features may pose a diagnostic challenge to the pathologist, especially at the time of frozen section examination, because they may resemble other spindle cell neoplasms more common to that location, such as fibrous meningothelial tumors. We report a case of intrasellar and parasellar cellular schwannoma lacking common and reliable neurilemmomatous features, such as the coexistence of cellular Antoni A and loose Antoni B areas, Verocay bodies, and hyalinized thickened vessels. In addition, features infrequently seen in schwannomas were identified in the specimen, including the presence of psammoma bodies, nuclear optically clear pseudoinclusions, and fine intracytoplasmic melanin-like pigment. Ultimately, the use of immunohistochemistry was necessary to achieve a definitive pathologic diagnosis. Cellular schwannoma expands the pathologic differential diagnosis of spindle cell neoplasms of sellar location that the pathologist should have in mind, especially at the time of frozen section examination. The clinical, histopathologic, and neurosurgical aspects of primary cellular schwannomas of the sella turcica are reviewed.

Rhodococcus spp. are opportunistic pleomorphic aerobic gram-positive bacteria that usually cause infection in the context of hosts with cellular immune deficiency. Initially described as a common zoonotic pathogen in foals, infection in humans has been more commonly reported since the emergence of the AIDS epidemics. Pulmonary cavitary lesions are, by far, the most common clinical manifestation, but virtually any organ may be affected, usually because hematogenous spread of this bacterium. Clinically significant infection in immunocompetent hosts is a rare event, especially when the site of involvement is extrapulmonary. Primary brain Rhodococcal abscesses are very unusual and, to the best of our knowledge, they have never been documented in immunocompetent individuals in the absence of direct inoculation of the organism. We report a peculiar case of Rhodococcus spp. causing a primary brain abscess in an immunocompetent man. The clinician should be aware of potential laboratory pitfalls in the identification of Rhodococcus spp., as its diphtherioid morphology may prompt discarding the organisms as a contaminant. The importance of identifying the causative organism is paramount to adequately select antimicrobial therapy, particularly in the clinical setting of central nervous system (CNS) infection, where antibiotics are not only selected according to their bactericidal properties but also taking in consideration the blood-brain barrier permeability of the drug. Therefore, the optimal therapeutic approach of Rhodococcus spp. brain infections relies on surgical drainage plus relatively long-term multi-drug antimicrobial treatment, preferably based on drug sensitivity analysis. This article reviews the clinical and pathologic features of Rhodococcus spp. infection as an emerging opportunistic pathogenic organism in immunocompromised and immunocompetent individuals.

Despite treatment with potent and effective combination antiretroviral medications, the incidence of non-Hodgkin lymphoma (NHL) in the population living with HIV/AIDS remains significantly higher than that in noninfected individuals. The majority of the HIV-infected patients with NHL present with advanced stage extranodal disease of the B-cell phenotype. Lymphomas are the second most common tumors involving the heart in HIV-infected patients. Although the heart may serve as the primary focus of the lymphoma, in most HIV-related cases, cardiac lymphomatous involvement is part of a metastatic process that originated elsewhere.

Chronic intestinal inflammation culminates in cancer and a link to Toll-like receptor-4 (TLR4) has been suggested by our observation that TLR4 deficiency prevents colitis-associated neoplasia. In the current study we address the effect of the aberrant activation of epithelial TLR4 on induction of colitis and colitis-associated tumor development. We take a translational approach to address the consequences of increased TLR signaling in the intestinal mucosa.Mice transgenic for a constitutively active TLR4 under the intestine-specific villin promoter (villin-TLR4 mice) were treated with dextran sodium sulfate (DSS) for acute colitis and azoxymethane (AOM)-DSS TLR4 expression was analyzed by immunohistochemistry in colonic tissue from patients with ulcerative colitis (UC) and UC-associated cancer. The effect of an antagonist TLR4 antibody (Ab) was tested in prevention of colitis-associated neoplasia in the AOM-DSS model.Villin-TLR4 mice were highly susceptible to both acute colitis and colitis-associated neoplasia. Villin-TLR4 mice had increased epithelial expression of COX-2 and mucosal PGE₂ production at baseline. Increased severity of colitis in villin-TLR4 mice was characterized by enhanced expression of inflammatory mediators and increased neutrophilic infiltration. In human UC samples, TLR4 expression was upregulated in almost all colitis-associated cancer and progressively increased with grade of dysplasia. As a proof of principle, a TLR4/MD-2 antagonist antibody inhibited colitis-associated neoplasia in the mouse model.Our results show that regulation of TLRs can affect the outcome of both acute colitis and its consequences, cancer. Targeting TLR4 and other TLRs may ultimately play a role in prevention or treatment of colitis-associated cancer.

On occasion, the placement of orthopedic prosthetic components or stabilization hardware leads to surgical site infections, in some cases presenting at a point in time distant from the surgical procedure. Although infectious complications are the most common etiology for surgical site pain and inflammation, malignancies can also develop around prosthetic devices and metallic implants. When encountered, such malignancies are most often sarcoma, but rarely B-cell non-Hodgkin's lymphoma has also been described. In this article, we describe what we believe to be the first published case of anaplastic large T-cell lymphoma associated with a stainless steel fixation plate that was implanted several years earlier for repair of a tibial fracture. Appropriate to this case, we review the medical literature on the association of orthopedic implants with the development of neoplasm, along with the theorized pathogenic mechanisms leading to such an association.

A 46-year-old woman presented with shortness of breath and frequent lower respiratory tract infections. A ventilation-perfusion scan showed markedly reduced perfusion of the right lung, and pulmonary arteriogram showed stenosis of the right pulmonary artery. A right pneumonectomy revealed dense white fibrous bands partially occluding the pulmonary artery branches and two large abscess cavities filled with pus in the upper and lower lobes. Microscopic examination revealed extensive necrosis of lung parenchyma, suppurative granulomatous inflammation with Coccidioides immitis organisms and rare acid-fast bacilli. Pulmonary artery fibrous bands were originally believed to be congenital; however, they are now known to be sequelae of thromboembolic phenomena.

Amebic encephalitis caused by Balamuthia spp is an increasingly recognized chronic granulomatous central nervous system infectious process, which may affect both immunocompetent and immunocompromised individuals. The course of the disease is insidious and fatal in most cases, mainly due to delayed diagnosis, difficulty in isolation and/or identification of the organism, and lack of well-established amebicidal therapeutic regimens. This article reviews the clinicopathologic characteristics of infections caused by Balamuthia mandrillaris compared to other pathogenic free-living amebae and summarizes the latest diagnostic and therapeutic advances in infections caused by Balamuthia spp.

Tacrolimus (TAC), a widely used nephrotoxic calcineurin inhibitor, is associated with renal vasoconstriction possibly through adenosine receptor activation. Theophylline (THEO), an adenosine receptor inhibitor, protects against the nephrotoxicity of drugs associated with renal vasoconstriction. We hypothesized that coadministration of low dose THEO in rats would prevent TAC-induced nephrotoxicity. Sprague-Dawley rats pair-fed a low-sodium diet were randomized into three groups ( n=10/group): the control (CONTROL) group received the vehicle for both medications; the TAC group received TAC 6 mg/kg/day and vehicle; and the TAC+THEO group received TAC and THEO 17 mg/kg/day. On day 21, a timed urine collection was obtained for creatinine clearance. On day 22, serum creatinine, THEO and whole blood TAC concentrations were determined. One kidney was removed for formalin fixation and histological assessment. In the TAC group, serum creatinine increased while creatinine clearance decreased compared to CONTROL (0.3+/-0.0 vs. 0.4+/-0.0 mg/dl and 0.53+/-0.06 vs. 0.34+/-0.04 ml/min/100 g body weight respectively, p0.05), while TAC+THEO did not differ from control. There were no significant differences in renal histology. Concurrent administration of low-dose THEO prevented the TAC-induced decline in renal function, consistent with a role for adenosine in TAC-induced nephrotoxicity.

Primary Hodgkin lymphoma of the gastrointestinal tract is exceedingly rare to the point that some authors regard with skepticism the existence of this entity. Cases of gastrointestinal Hodgkin lymphoma have been reported previously; however, most of these cases represented secondary involvement of the digestive tract in the context of systemic disease. Other cases have been reclassified in retrospective studies as non-Hodgkin lymphomas after the application of immunohistochemical techniques. We report a case of primary Hodgkin lymphoma of the gastrointestinal tract in a patient who presented with obstructive symptoms at the site of a gastroileal bypass; the bypass had been performed years earlier because of morbid obesity. Some non-Hodgkin lymphomas may morphologically mimic Hodgkin lymphoma and vice versa; therefore, an accurate pathologic diagnosis is important, since the therapeutic approach and prognostic implications differ significantly for these diseases. In this context, immunohistochemistry should be used to confirm or to exclude the histologic diagnosis of Hodgkin lymphoma.

Background Intestinal allograft biopsies limit histopathological analysis to the superficial layers of the bowel. These biopsies allow a reasonable assessment of the histological features of acute rejection, but characteristics of chronic injury in mucosal layers remain poorly defined because of the limitations posed by endoscopic sampling. Experimental work has inferred that intestinal mucosal fibrosis may be indicative of chronic rejection; however, a temporal, graded study of mucosal fibrosis has not been performed. Methods A total of 79 endoscopic intestinal allograft biopsies from 12 patients obtained at 3 to 120 days posttransplantation were evaluated. Fibrosis and individual parameters of acute cellular rejection were graded according to a semiquantitative scoring system and were evaluated for potential relationships with each other. Results We found that while acute rejection tends to occur early in the posttransplant period, fibrosis of the lamina propria increases at a later time, particularly in the third and fourth month. Several individual graded parameters of acute rejection had an association with fibrosis at the same time points. Conclusions Fibrous replacement of the lamina propria in human endoscopic allograft biopsies occurs with advancing time after transplantation. Acute rejection precedes and may have some eventual impact upon the amount of fibrosis present. A measurement of the connective tissue component of bowel transplant tissue may serve as a harbinger of long-term enteral allograft dysfunction.

The tendency toward hypertension or higher blood pressure is more common in blacks than whites. The factors that account for these differences are attributed to both environmental and genetic factors. To clarify this issue, an anthropological study of black and nonblack populations in the lowland village of Chicaloma, northeastern Bolivia at a midaltitude of 1,800 m was conducted. The study included 159 subjects, of which 79 were black and 80 were nonblack, 17-78 years. The study suggests the following: (1) the socioeconomic status of blacks as measured by an ownership index is greater than that of nonblacks, (2) blacks had higher average systolic and diastolic blood pressures than nonblacks and showed an age-associated increase in blood pressures, (3) the prevalence of hypertension was higher for blacks (7-6%) than nonblacks (1.3%), but three times lower than among blacks in the United States, (4) skin reflectance is inversely related to blood pressures so that contrary to what has been suggested the darker the skin color, the higher the blood pressures even at comparable levels of affluence. These findings together suggest that genetic factors predispose black individuals to increased blood pressures, but the expression of clinical hypertension is influenced by adverse unaccounted environmental factors. Am. J. Hum. Biol. 11:489-498, 1999. Copyright 1999 Wiley-Liss, Inc.

A 57-year-old woman presented with intermittent symptoms of intestinal obstruction. Workup provided nondiagnostic radiologic studies. An exploratory laparotomy revealed a segmental dilatation in the proximal ileum, which showed diffuse thickening of the intestinal wall. Microscopic examination of the affected area disclosed a diffuse transmural infiltrate composed of small lymphocytes, mature plasma cells, and lymphoplasmacytoid cells in different stages of maturation associated with extracellular periodic acid-Schiff–positive material. In addition, serum protein electrophoresis showed a monoclonal immunoglobulin M κ paraprotein. Postoperative workup did not demonstrate evidence of systemic involvement. The morphologic features and immunohistochemical and molecular analyses were consistent with lymphoplasmacytoid lymphoma (immunocytoma). We report an unusual case of primary extranodal immunocytoma involving the small intestine and discuss its clinicopathologic features.

Balloon cells are altered melanocytes with clear vacuolated cytoplasm caused by a defect in the process of melanogenesis. Although rare, balloon cell change has been observed in a variety of melanocytic proliferations, particularly intradermal melanocytic nevi and melanoma. When present, such features may lead to difficulties in diagnosis, particularly with other clear cell neoplasms. We report an unusual case of the development of balloon cell change in a cellular blue nevus, a phenomenon that has not been extensively addressed in the literature. The importance of recognizing this change in cellular blue nevus to avoid misinterpreting the lesion as malignant is discussed.

We report a case of predominantly intraductal carcinoma of the pancreas with microscopic foci of invasive carcinoma in a patient with chronic pancreatitis. In this article, we discuss the pathologic and prognostic features of pancreatic carcinoma in situ. This entity is probably overlooked due to a number of reasons, including the fact that, in most cases, pancreatic ductal carcinomas are extensively infiltrative at the time of surgical removal; the atypical epithelial changes in the intraductal carcinoma had been overlooked in the presence or absence of an invasive component; epithelial changes may be missed due to insufficient sampling; and last, the differentiation with atypical epithelial hyperplasia is a subjective matter. Intraductal carcinoma of the pancreas is a distinct pathological entity with characteristic morphologic changes restricted to the ductal epithelium, bearing important prognostic implications.

Ten years ago, just weeks after the September 11 attacks, the United States experienced a deliberate act of bioterrorism. Through use of the postal service, anthrax spores were widely disseminated, including to homes, the Senate, and major newsrooms, resulting in morbidity and mortality and effectively disrupting our way of life and revealing our vulnerability. Even though such attacks had been the subject of much writing and had been planned for, detection of and the appropriate response to an attack with an agent from the so-called "Category 'A' List" had only been considered in theoretical terms. What transpired during the following difficult weeks, including how public health and federal government agencies performed, has been both praised and criticized. An intertwined epidemiologic and criminal investigation of such magnitude was unprecedented in U.S. history. To address the question of whether we as a nation are now better prepared for future threats involving biologic agents, it is important to learn from the lessons of the 2001 anthrax attacks, including the critical role of clinicians in surveillance. As physicians involved in diagnosing anthrax in the index case and alerting authorities, we offer our perspective on these events a decade after their occurrence.