Development and external validation of a dynamic prognostic nomogram for primary extremity soft tissue sarcoma survivors.

Background: Prognostic nomograms for patients with extremity soft tissue sarcoma (eSTS) typically predict survival or the occurrence of local recurrence or distant metastasis at time of surgery. Our aim was to develop and externally validate a dynamic prognostic nomogram for overall survival in eSTS survivors for use during follow-up.

Methods: All primary eSTS patients operated with curative intent between 1994 and 2013 at three European and one Canadian sarcoma centers formed the development cohort.

Impact of perioperative chemotherapy and radiotherapy in patients with primary extremity soft tissue sarcoma: retrospective analysis across major histological subtypes and major reference centres.

Background: The role of radiotherapy (RTx) and chemotherapy (CTx) in primary extremity soft tissue sarcoma (eSTS) patients is not precisely defined.

Methods: All consecutive primary eSTS patients treated within three European and one North American reference centres in a 20-year time span were included. The tendency to perform chemotherapy/radiotherapy (CTx/RTx) was explored using multivariable binary logistic models.

Development and external validation of two nomograms to predict overall survival and occurrence of distant metastases in adults after surgical resection of localised soft-tissue sarcomas of the extremities: a retrospective analysis.

Background: The current American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system does not have sufficient details to encompass the variety of soft-tissue sarcomas, and available prognostic methods need refinement. We aimed to develop and externally validate two prediction nomograms for overall survival and distant metastases in patients with soft-tissue sarcoma in their extremities.

Methods: Consecutive patients who had had an operation at the Istituto Nazionale Tumori (Milan, Italy), from Jan 1, 1994, to Dec 31, 2013, formed the development cohort.

Mucinous tumor of the appendix with limited peritoneal spread: is there a role for expectant observation?

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is now the standard management for mucinous tumors of appendiceal origin at many centers. We examined the role of expectant observation (EO) in patients who had undergone an initial resection at the time of referral to our center and who had limited residual disease.

Methods: We performed a retrospective review of patients referred to Mount Sinai/Princess Margaret Hospitals, Toronto, for consideration of surgical management of peritoneal malignancy between January 1998 and December 2009.

Susceptibility of community Gram-negative urinary tract isolates to mecillinam and other oral agents.

Objective: To determine the susceptibility of community outpatient Gram-negative urinary tract isolates to mecillinam and other commonly used oral agents.

Design And Setting: The study was a laboratory-based study of consecutive Gram-negative urinary tract isolates. Only those isolates considered to be significant pathogens were included in the study.

Skin and soft tissue infection: necrotizing fasciitis.

The incidence of necrotizing fasciitis has increased in the past decade as a result of the resurgence severe group A streptococcal infection. Mortality has remained unchanged over the past 60 years, supporting the notion that immune modulators, such as intravenous immunoglobulin, are required to alter the physiological process during the early stages of infection.

Genetics and proteomics of pituitary tumors.

Genetics and proteomics determine structure and function of normal tissues, and the molecular alterations that underlie tumorigenesis result in changes in these aspects of tissue biology in neoplasms. We review the known genetic alterations in pituitary tumors. These include the oncogenic Gsalpha protein (GSP)-activating mutations, and pituitary tumor-derived fibroblast growth factor receptor-4 (ptd-FGFR4), as well as tumor suppressor gene mutations associated with multiple endocrine neoplasia type 1 (MEN1).

The molecular pathogenetic role of cell adhesion in endocrine neoplasia.

It is becoming increasingly evident that cell adhesion is an important determinant of organised growth and the maintenance of architectural integrity. Indeed, reduced adhesiveness between cells and with the extracellular matrix is a hallmark of neoplastic growth. In neuroendocrine tissues, neural cell adhesion molecule is implicated in modulating cell growth, migration, and differentiation.

Zanamivir use during transmission of amantadine-resistant influenza A in a nursing home.

Objective: To describe the use of zanamivir during an influenza A outbreak.

Population: Residents of a 176-bed long-term-care facility for the elderly in Newmarket, Ontario, Canada, 90% of whom received influenza vaccine in the fall of 1998.

Outbreak: When respiratory illness due to influenza A was confirmed, infection control measures and amantadine prophylaxis were initiated.

Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome--a comparative observational study. The Canadian Streptococcal Study Group.

Twenty-one consecutive patients with streptococcal toxic shock syndrome (TSS) between December 1994 and April 1995 were treated with a median dose of 2 g of intravenous immunoglobulin (IVIG)/kg (cases) and were compared with 32 patients with streptococcal TSS between 1992 and 1995 who did not receive IVIG therapy (controls). The outcome measure was 30-day survival. Patient plasma was tested for its ability to inhibit T cell activation induced by the infecting strain.

In vitro activities of fluoroquinolones against antibiotic-resistant blood culture isolates of viridans group streptococci from across Canada.

Among 418 blood culture isolates of viridans group streptococci obtained between 1995 and 1997, the in vitro rates of nonsusceptibility to penicillin, erythromycin, tetracycline, and trimethoprim-sulfamethoxazole were 28, 29, 24, and 14%, respectively. The most prevalent group (125 strains) was Streptococcus mitis, followed by Streptococcus sanguis (56 strains). For 236 (56%) strains resistant to one or more antibiotics, the ciprofloxacin MIC at which 90% of the isolates were inhibited (MIC(90)) was 4 microg/ml, whereas the MIC(90)s of trovafloxacin, grepafloxacin, and gatifloxacin were 0.

Prevalence and mechanisms of macrolide resistance in clinical isolates of group A streptococci from Ontario, Canada.

A total of 3,205 group A streptoccal isolates were collected in 1997 through a private laboratory which serves community physicians in southern Ontario and which represents a population base of 6 million people. Nonsusceptibility to erythromycin was detected for 67 (2.1%) isolates both by disk diffusion and by broth microdilution.

Control of transmission of vancomycin-resistant Enterococcus faecium in a long-term-care facility.

Objectives: To describe the investigation and control of transmission of vancomycin-resistant enterococci (VRE) in a residential long-term-care (LTC) setting. OUTBREAK INVESTIGATION: A strain of vancomycin-resistant Enterococcus faecium not previously isolated in Ontario colonized five residents of a 254-bed LTC facility in Toronto. The index case was identified when VRE was isolated from a urine culture taken after admission to a local hospital.

Molecular characterization of multidrug resistance in Streptococcus mitis.

Antimicrobial resistance was characterized for 14 strains of Streptococcus mitis. HinfI restriction fragment length mapping of gyrA PCR amplicons from three ciprofloxacin-resistant isolates correlated with mutations associated with such resistance in other organisms. By using PCR, seven erythromycin-resistant strains were found to possess either the mef or ermB gene.

A cross-Canada surveillance of antimicrobial resistance in respiratory tract pathogens.

Objective: To determine the prevalence of antimicrobial resistance in clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis from medical centres across Canada.

Methods: Fifty laboratories from across Canada were asked to collect up to 25 consecutive clinical isolates of S pneumoniae, H influenzae and M catarrhalis at some time between September 1994 and May 1995, and then again between September and December of 1996. A total of 2364 S pneumoniae, 575 H influenzae and 200 M catarrhalis samples were collected.

In vitro activity of cefepime against multidrug-resistant Gram-negative bacilli, viridans group streptococci and Streptococcus pneumoniae from a cross-Canada surveillance study.

Objective: To determine the in vitro activity of cefepime against multidrug-resistant Gram-negative bacilli and Gram-positive cocci obtained from an ongoing cross-Canada surveillance study.

Design: Clinical isolates of aerobic Gram-negative bacilli with inducible and constitutive chromosomally mediated cephalosporinases, viridans group streptococci and Streptococcus pneumoniae were collected from laboratories serving hospitals, nursing homes and physician offices in the community from across Canada during 1996 and 1997. Laboratories were asked to submit only clinically relevant nonduplicate isolates for susceptibility testing.

Prevalence and characterization of the mechanisms of macrolide, lincosamide, and streptogramin resistance in isolates of Streptococcus pneumoniae.

Of a total of 147 erythromycin-resistant Streptococcus pneumoniae isolates, 64 (43.5%) were resistant to erythromycin, clindamycin, and streptogramin B (MLSB phenotype), 57 of which possessed the ermB gene. Eighty-two (55.

Oligella infections: Case report and review of the literature.

A case of Oligella ureolytica infection of a cervical lymph node is presented and previous cases of oligella infection reported in the literature are reviewed. Underlying malignancy and urinary tract obstruction were observed in many of the cases. All patients responded to antimicrobial therapy and, in those cases associated with urinary tract obstruction, surgical relief of the obstruction.

Comparative activity of cefepime with several antimicrobials against aerobic Gram-negative and Gram-positive organisms isolated from patients across Canada in 1993.

To compare the activity of cefepime, a fourth-generation cephalosporin, with several available antimicrobials, in vitro susceptibility studies were carried out on bacteria commonly associated with various infections, including sepsis. Ten tertiary care hospital laboratories in six provinces provided 1276 clinically relevant isolates of aerobic Gram-negative bacilli and Gram-positive cocci during 1993. When the activity of each of the antimicrobials was determined against all isolates submitted, cefepime, piperacillin/tazobactam, imipenem and ciprofloxacin all had minimal inhibitory concentrations for 90% of the organisms (mic(90)) two or more dilutions below the mic resistant category.

Epidemiological typing of Moraxella catarrhalis by pulsed field gel electrophoresis.

Pulsed field gel electrophoresis (pfge) was used to compare 59 strains of Moraxella catarrhalis to evaluate pfge for the epidemiological typing of this organism. pfge-generated patterns were compared with those obtained by small fragment restriction enzyme analysis (rea) and species-specific probe hybridization. The strains used in the study were isolated from various geographic locations and included proven epidemiologically related strains.

The use of molecular biology techniques for diagnostic microbiology and hospital epidemiology.

Clinical microbiologists and hospital epidemiologists have traditionally been concerned with the isolation and identification of organisms for diagnosis in individual patients, and the detection of transmission of such organisms from patient to patient. The use of molecular biology techniques, such as nucleic acid probing and amplification, provides the potential for revolutionizing how we diagnose infecting pathogens and determining the relation between nosocomial isolates. In clinical microbiology, this means that we will be able to detect smaller amounts of DNA or RNA of pathogens than is currently possible, that the time required to identify and determine the antimicrobial susceptibility of slow-growing pathogens will be dramatically reduced, and that the diagnosis of nonculturable organisms will become possible.

Comparative activity of several antimicrobial agents against nosocomial Gram-negative rods isolated across Canada.

In 1992, a surveillance study was performed in Canada to determine the susceptibility of nosocomial Gram-negative rods to several wide spectrum antimicrobials. Consecutive isolates from 10 institutions, as well as additional strains of selected species of Enterobacteriaceae that are known to possess the Bush group 1 beta-lactamase, were tested for susceptibility to 12 antimicrobials. Third-generation cephalosporin resistance was found to be as high as 29% in Enterobacter cloacae that possesses the Bush group 1 beta-lactamase and less than 4% in those isolates not possessing this enzyme.