A new technique using pulsed Doppler echocardiography for non-invasive recording of blood flow velocity patterns at the site of the mitral annulus is described. In a control group of 30 subjects in whom an organic or functional lesion of the mitral valve had been ruled out, the normal flow velocity pattern was found to be similar to that obtained either experimentally by other authors using an implanted electromagnetic cuff flowmeter or clinically by our group using the transseptal catheterisation continuous wave Doppler technique. In 31 patients with confirmed mitral valve disease, the mitral valveflow velocity patterns were correlated with the clinical and haemodynamic data, and in 10 cases the patterns were compared with the flow velocity curves recorded in the same patients using the Doppler ultrasonic transseptal catheterisation of the mitral valve. In most cases, characteristic anomalies of these patterns were noted and could be related to the type of the lesion, stenosis, regurgitation, or a combination of these.Specific patterns of mitral valve flow velocity profiles were shown to correlate satisfactorily with the degree of the lesion, with some reservations for mitral regurgitation. Though not fully quantitative, the pulsed Doppler technique is a new and promising non-invasive methodfor establishing the diagnosis of mitral stenosis and/or regurgitation, and to some extent, grading the severity of mitral valve disease using pattern recognition. It provides an original approach to the understanding of mitral haemodynamic disturbances on a beat-to-beat basis.The paramount importance of the knowledge of instantaneous transmitral blood flow for our understanding of/and our ability to diagnose accurately mitral valve disease has been recently stressed (Kalmanson, 1976). We have previously shown the diagnostic use of continuous wave Doppler ultrasonic transseptal catheterisation of the mitral valve for such purposes (Kalmanson et al., 1975a, b). Unfortunately, the cumbersome and traumatic nature of such a procedure somewhat restricts its routine application in clinical cardiology and therefore led us to search for a non-invasive technique for investigating mitral valve flow.In 1973 S.).Received for publication 6 September 1976 blood flow using the combined transcutaneous pulsed Doppler and conventional echocardiographic procedures. At our request, the audio frequency output signal of the pulsed Doppler was demodulated by means of a frequency-to-voltage converter and a single continuous curve was thus substituted for the frequency spectral display previously necessary to interpret the output signal. A new method was devised and tested by our group for recording blood flow velocity patterns from the heart valves. The encouraging results are presented here. Subjects and methodsWe first studied a control group of 30 subjects, 13 women and 17 men, ranging in age from 7 to 40 years, all with normal hearts or in whom organic or 517 on 11 May 2018 by guest. Protected by copyright.

IMPORTANCE Ex vivo dermoscopy (EVD) with derm dotting (DD) improves clinicopathologic correlation and the quality of diagnosis in skin tumors. OBJECTIVE To compare the diagnostic performance of the standard method of skin biopsy processing with the practice of EVD with DD. DESIGN, SETTING, AND PARTICIPANTS This retrospective study compares the diagnostic performance in 6526 skin biopsy specimens examined from 2008 to 2010 with a standard method of processing with 8584 biopsy specimens examined in 2015 with EVD and DD. Data were analyzed from January 1 to March 31, 2016. A total of 15 110 skin biopsy specimens were included. The biopsy specimens from 2008 to 2010 were processed in a hospital-based general pathology laboratory; the biopsy specimens from 2015 were processed in a private dermatopathology laboratory. Biopsy specimens from both periods were diagnosed by the same dermatopathologist. MAIN OUTCOMES AND MEASURES The primary outcome measures were clinicopathological characteristics, usefulness of EVD with DD, and turnaround times (TATs). RESULTS Use of EVD with DD increased the detection of positive section margins in nonmelanoma skin cancer from 8.4% to 12.8%. The most significant increase was seen in Bowen disease, invasive squamous cell carcinoma, and a superficial type of basal cell carcinoma (BCC). With EVD and DD, a specific clinicopathologic diagnosis was made in 27.7% of nevi compared with only 10.3% using the standard method. The incidence of moderately and severely dysplastic nevi increased from 1.0% to 7.2% and from 0.6% to 1.4%, respectively. The detection of ulceration in melanomas with thicker than 1 mm increased from 24.0% to 31.3%. The number of nevi-associated melanomas increased from 15.5% to 33.3%. The number of collision lesions from 0.07% to 1.07%. The TAT for nevi decreased from 2 days to 1 day, for melanomas from 5 days to 2 days, and for BCC from 2 days to 1 day. CONCLUSIONS AND RELEVANCE Ex vivo dermoscopy and DD with adapted sectioning in a dermatopathology setting allows a more accurate and less time consuming histopathologic diagnosis of skin tumors. These findings suggest that pathologists involved in skin tumor evaluation should be encouraged to learn dermoscopy and replace random transverse cutting with lesion-specific and DD-guided cutting.

Objective: To retrospectively analyze the accuracy of simplified multiparametric MRI at 1.5 T for local staging by using whole-mount-section histopathological analysis as the standard of reference. Methods: 123 consecutive patients underwent T 2 weighted, T 1 weighted and diffusion-weighted MRI without endorectal coil prior to radical prostatectomy. The accuracy of predicting extracapsular extension (ECE) (T3a) was assessed using direct signs or the combination of direct and indirect signs of extraprostatic extension. The accuracy of predicting seminal vesicle invasion (T3b) was evaluated, taking into account different routes of seminal vesicle involvement. Finally, adjacent organ invasion (T4) was evaluated in this patient population. Results: Histopathology showed T3a, T3b and T4 in 61, 28 and 9 cases, respectively. The use of direct signs of extraprostatic extension showed a sensitivity of 57.4% and specificity of 91.9%. The combination of direct signs and indirect signs improved sensitivity (85.2%) at the expense of moderate loss of specificity (83.9%). MR sensitivity for the detection of seminal vesicle invasion was low (53.6%); however, it was dependent on the route of seminal vesicle tumour infiltration. MR sensitivity and specificity for adjacent organ invasion were 88.9% and 99.1%. Conclusion: Simplified MRI study at 1.5 T provides a relatively high sensitivity for detecting ECE (T3a) when using the combination of indirect and direct signs. However, this high sensitivity reading is at the cost of a moderate loss of specificity. Invasion of the seminal vesicles (T3b) occurs most often along the ejaculatory duct complex with low MR sensitivity. Advances in knowledge: Simplified MRI study at 1.5 T without endorectal coil could be used for the local T staging of prostate cancer.

In Helicobacter pylori gastritis, constant antigenic stimulation triggers a sustained B-cell proliferation. Errors made during this continuous DNA replication are supposed to be corrected by the DNA mismatch repair mechanism. Failure of this mismatch repair mechanism has been described in hereditary non-polyposis colorectal cancer (HNPCC) and results in a replication error phenotype. Inherent to their instability during replication, microsatellites are the best markers of this replication error phenotype. We aimed to evaluate the role of defects in the DNA mismatch repair (MMR) mechanism and microsatellite instability (MSI) in relation to the most frequent genetic anomaly, translocation t(11;18)(q21;q21), in gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Therefore, we examined 10 microsatellite loci (BAT25, BAT26, D5S346, D17S250, D2S123, TGFB, BAT40, D18S58, D17S787 and D18S69) for instability in 28 patients with MALT lymphomas. In addition, these tumors were also immunostained for MLH1, MSH2, MSH6 and PMS2, as well as screened for the presence of t(11;18)(q21;q21) by real-time polymerase chain reaction (RT-PCR). We found MSI in 5/28 (18%) lymphomas, with MSI occurring in both t(11;18)(q21;q21)-positive and -negative tumors. One tumor displayed high levels of instability, and, remarkably, this was the only case displaying features of a diffuse large B-cell lymphoma. All microsatellite unstable lymphomas showed a loss of MSH6 expression. In conclusion, our data suggest that a MMR-defect may be involved in the development of gastric MALT lymphomas, and that a defect of MSH6 might be associated with those MSI-driven gastric lymphomas.