No abstract

Aims: Pleomorphic adenoma gene 1 (PLAG1) gene rearrangement is the most common genetic abnormality in pleomorphic adenoma (PA), resulting in overexpression of PLAG1 protein. PA and carcinoma ex pleomorphic adenoma (CA ex-PA) can mimic various benign and malignant salivary gland tumours. The aims of this study are to evaluate the sensitivity and specificity of PLAG1 immunohistochemistry (IHC) in the differential diagnosis of PA and CA ex-PA and to compare the PLAG1 immunohistochemical results to PLAG1 gene abnormalities as detected by fluorescence in-situ hybridisation (FISH). Methods and results: PLAG1 immunostaining was performed on 83 salivary gland tumours, including 23 PA, 15 CA ex-PA and 45 other salivary gland tumours. In addition, PLAG1 FISH was performed in 44 cases for the presence of gene rearrangements/ amplifications. The results showed high sensitivity of PLAG1 IHC in 96% of PA; however, discordant results between PLAG1 FISH abnormalities and IHC were noted in 15 of 44 cases (34%). Seven PA, four de-novo myoepithelial carcinomas and one basal cell adenocarcinoma had negative FISH results, but were positive for IHC; while three salivary duct carcinomas (SDC) ex-PA were positive for FISH but negative for IHC. PLAG1 IHC can differentiate CA ex-PA from de-novo SDC (P = 0.02), but not from de-novo myoepithelial carcinoma. PLAG1 IHC is a sensitive marker for PA. This could be due to PLAG1 gene abnormalities beyond FISH resolution. Conclusions: A negative PLAG1 IHC might be helpful in excluding a PA diagnosis. Interestingly, in the context of CA ex-PA, FISH is more sensitive than IHC in detecting PLAG1 abnormalities.

Background-Acute increases in serum inorganic phosphorus (Pi) up to 4.75 mmol/l in the absence of hypocalcemia and tissue deposition of calcium phosphate were noted in 3 patients receiving liposomal amphotericin B (L-AMB). We investigated L-AMB as a possible cause of pseudohyperphosphatemia.Methods-Serum samples from the index patient were analyzed for Pi content by our laboratory's primary analyzer (Synchron LX20 ) and by an alternate analyzer (Vitros). Clear and lipemic serum pools, and normal saline, were spiked with L-AMB and analyzed by the LX20 Pi method. Ultrafiltration studies were performed on patient and spiked sera.Results-Increased Pi values were obtained only from the LX20 analyzer. There was a direct linear relationship between the concentration of L-AMB in the spiked samples and the LX20 Pi results, indicating a 0.9 mmol/l Pi increase for every 100 mg/l increase in L-AMB. Ultrafiltration normalized the Pi results.Conclusion-Serum Pi results may be falsely increased in patients receiving L-AMB when measured by the LX20 analyzer. This novel cause of pseudohyperphosphatemia is due to interference of L-AMB with the method and is corrected by ultrafiltration of the specimen. Since the LX20 1 Presented in part at the

The majority of USAF primary care providers surveyed were not familiar with CDC-recommended annual screening tests for STIs in MSM, and they did not screen for MSM activity or offer MSM STI screening tests regularly. Further studies across the Department of Defense are needed to corroborate the findings of this study.

The efficacy of an antibiotic support team (AST) has been demonstrated in both large teaching hospitals and smaller community hospitals. The usefulness of an AST in a medium-sized military hospital was investigated in the present study. Patients at least 18 years old hospitalized at the David Grant USAF Medical Center (DGMC) and receiving > or =1 of 17 specified antibiotics for > or =3 consecutive days were randomized to an educational intervention group or control group. Primary endpoints included antibiotic defined daily dose (DDD) per patient treatment course and days of antibiotic therapy (DOT) per patient. Fifty-two patients were analyzed from March to August 2006. DDD per patient treatment course was significantly lower in the intervention group, (6.7 +/- 7.6 vs. 12.9 +/- 16.3, p = 0.05). A trend toward fewer DOT per patient was seen in the intervention vs. control group. Implementation of an AST decreased the intensity of exposure to antibiotics.