A 56-year-old male with chronic renal failure presented with a 6 month history of progressive dyspnoea. High resolution CT of the chest showed multiple, peripheral, centrilobular nodules in the upper and mid zones, consistent with metastatic pulmonary calcification. Some of these pulmonary nodules showed ring calcification, a pattern that to our knowledge has not been described before. Calcification was also seen in the segmental pulmonary arteries, bronchi, trachea and subcutaneous vessels of the chest wall.
NECs are aggressive with generally poor prognosis, characterized by insidious onset and advanced clinical stage of presentation. A radical approach to treatment with chemotherapy is the best form of palliation. Role of radiotherapy remains undefined due to paucity of data.
Background: To assess the immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor-2 (HER2) neu receptor in breast cancer and their associations with various clinicopathological characteristics. Materials and Methods: This is a retrospective analysis of women who presented with primary, unilateral breast cancer in the Department of Medical Oncology at Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India during the period from January 2008 to December 2011. Data were retrieved from the medical records of the hospital including both early and locally advanced cancer cases. ER, PgR and HER2neu expression in these patients was assessed and triple negative patients were identified. Associations of triple negative and non-triple negative groups with clinicopathological characteristics were also evaluated. Results: A total of 1,284 women (mean age 52.1 years, 41.9% premenopausal) were included in the analysis. Hormone receptor positivity (ER and/or PgR) was seen in 63.4% patients, while 23.8% of tumors were triple negative. Only 23.0% were HER2 positive. Around 10.0% of tumors were both ER and HER2 positive. ER and PgR positivity was significantly associated with negative HER2 status (p-value <0.0001). Younger age, premenopausal status, higher tumor grade, lymph node negativity, advanced cancer stage, and type of tumor were strongly associated with triple negativity. Significantly, a smaller proportion of women had ductal carcinoma in situ in the triple negative group compared with the non-triple negative group (35.6% versus 60.8%, p-value <0.01). Conclusions: The present analysis is one of the largest studies from India. The majority of the Indian breast cancer patients seen in our hospital present with ER and PgR positive tumors. The triple negative patients tended to be younger, premenopausal, and were associated with higher tumor grades, negative lymph nodes status and lower frequency of ductal carcinoma in situ.
Drilling to the bones is required to re-fix them at their appropriate location using the implants. During drilling some thermal and mechanical losses may be faced by the bone and surrounding tissues which may lead to the serious issue in terms of osteonecrosis. Osteonecrosis is one of the reasons for impaired healing process for the fractured bone and causes further complications like low pullout strength of cortical screws and bone crush. In order to maintain the low temperature during bone drilling, this study focused the thermal damages observed by the bone and its surrounding during bone drilling and compared the results of conventional and vibrational drilling techniques. Parametric optimization under the influence of vibrations was also studied. Drilling has been done with the both drilling technique, and results were recorded in terms of temperature raise. Optimal solution for drilling the bone has been accessed using Taguchi optimization technique. The morphological comparison has been done for conventional and vibrational drilled holes using histopathology of drilled bones sections. From Taguchi optimization, it was observed that R1F1A1 is the parametric combination which gives minimum thermal injury to the bone in case of vibrational bone drilling. Analysis of variance cleared that the all parameters involved significantly affect the results (P ≤ 0.05). Rotational speed was found to be the most influential factor among the all with 80.53%. Histopathology studies of bone specimens help to understand how heat generation affects the bone morphology during drilling. The specimens drilled with vibrational drilling show less damage in terms of osteonecrosis near the drill site which shows the significance of vibrational drilling in case of orthopedic surgeries. The raise in temperature during drilling is collective result of different drilling parameters. Vibrational drilling was observed a helping tool to control the thermal damage in bone drilling.
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