This is a report on 8 mediastinal tumours that occurred in young adults (19-43 years, mean: 29.4); predominantly in females (6/8). Initial symptoms consisted of thoracic pain and venectasia and in only one case in B symptoms. After surgical tumour reduction, radiation and/or chemotherapy, local recurrence was observed in each case under clinical care; abdominal spread is presently suspected in 3 patients; 3 died 11, 13 and 22 months after diagnosis. None developed leukaemia. The tumours are B-cell neoplasms with a characteristic immunophenotype: leucocyte common antigen+, common acute lymphoblastic leukaemia antigen-, B 1-antigen+, surface and cytoplasmic immunoglobulin-. Flow cytometry revealed DNA-diploidy in 7 cases and a moderately (3.2-3.8%) to extremely high (8.0-20.6%) S-phase component. The proliferation associated antigen Ki67 was detectable in 10-60% of the tumour cell nuclei, thus stressing the considerable or rapid growth. Histopathology is characterized by a diffuse growth pattern and a clearness and abundance of cytoplasm of the pleomorphic tumour cells, which vary in size and nuclear morphology from patient to patient. Apoptoses are more numerous than mitoses. Fibrosis and focal necrosis are common, sclerosis is present in 3 cases. We suggest that primary mediastinal lymphoma of B cell type is a novel B-lymphoma variant.

No abstract

This article reports eight primary mediastinal tumors occurring in young adults (19 to 43 years, mean 29.4 years), predominantly female (six of eight) adults. Most patients responded badly to aggressive therapy. Progression is presently noted in one patient; five patients died 10, 11, 13, 18, and 22 months after diagnosis. No patient developed leukemia. The tumors were highly proliferative, had a diffuse growth pattern, and comprised clear cells of variable size. They could not be classified histologically, but could, however, be immunohistologically characterized as B cell lymphomas. In all cases, the immunophenotype was LC+, cALLa-, CD19+, CD20+, CD21-, Ig (surface/cytoplasm)-, and PC-1+. In addition, the neoplastic cells exhibited variable defects in the expression of HLA-A,B,C and HLA-DR and inconstant expression of other B cell-restricted/associated antigens. This combination of immunophenotypical and clinical features suggests that the mediastinal clear cell lymphoma (MCCL) is a previously undescribed type of B cell lymphoma corresponding to the terminal steps of B cell differentiation.

SummaryBackground The prevention of pressure ulcers (PU) is an important public health issue owing to their substantial clinical and economic burden. Objectives To investigate predictors of incident PU in hospitalized patients and the performance of the Braden Scale in intensive care units (ICU) and normal care units (NCU). Methods We conducted a prospective cohort study including all inpatients treated at the University Hospital Carl Gustav Carus Dresden, Germany, between 2007 and 2011. Documentation comprised patient characteristics, Braden Scale and clinical signs of PU. The primary outcome was incident PU during inpatient treatment. Predictors of PU were explored by using univariate and multivariate logistic regression models. To evaluate the performance of the Braden Scale a receiver operating characteristics (ROC) curve analysis was applied.Results The overall incidence of PU during inpatient treatment was 0Á78%. A higher rate of PU was observed at ICU vs. NCU (4Á77% vs. 0Á59%). Multivariate analysis identified age [odds ratio (OR) 1Á04, 95% confidence interval (CI) 1Á035-1Á041 per year], female sex (OR 1Á11, 95% CI 1Á01-1Á22), length of stay (OR 17Á79, 95% CI 15Á46-20Á48 for 30 or more days vs. < 10 days) and admission from care facility compared with admission from home (OR 3Á14, 95% CI 2Á63-3Á75) as significant predictors of incident PU. The area under the ROC curve was 84Á89% at NCU and 69Á0% at ICU. Conclusions The identified predictors for incident PU may inform targeted, evidence-driven preventive measures to decrease the burden of PU.

No abstract