TSC in the kidney is expressed principally as renal cysts and angiomyolipomas. Both abnormalities may occur separately or together, and both are commonly multiple and bilateral. Cystic disease is sometimes so severe as to be confused with polycystic kidney disease, although the histopathologic findings are practically diagnostic of TSC. Severe cystic disease causes renal insufficiency; large angiomyolipomas predispose to life-threatening hemorrhage. Renal malignancies have been reported in what appears to be a significant number of patients. We hypothesize that the renal abnormalities result from cell hyperplasia and hypertrophy, much like the other abnormalities of tuberous sclerosis, such as cerebral tubers and cardiac rhabdomyomas. The renal abnormalities can therefore be regarded as an expression of the TSC gene, and their recognition as such carries importance for treatment and counseling.
The primarily Palearctic Diorhabda elongata species group is established for five Tamarix-feeding sibling species(tamarisk beetles): D. elongata (Brullé, 1832), D. carinata (Faldermann, 1837), D. sublineata (Lucas, 1849) REVISEDSTATUS, D. carinulata (Desbrochers, 1870), and D. meridionalis Berti & Rapilly, 1973 NEW STATUS. Diorhabdakoltzei ab. basicornis Laboissière, 1935 and D. e. deserticola Chen, 1961 are synonymized under D. carinulata NEWSYNONYMY. Illustrated keys utilize genitalia, including male endophallic sclerites and female vaginal palpi andinternal sternite VIII. Distribution, comparative biogeography, biology, and potential in biological control of Tamarix inNorth America are reviewed. Diorhabda elongata is circummediterranean, favoring Mediterranean and temperate forestsof Italy to western Turkey. Diorhabda carinata resides in warm temperate grasslands, deserts, and forests of southernUkraine south to Iraq and east to western China. Diorhabda sublineata occupies Mediterranean woodlands from Franceto North Africa and subtropical deserts east to Iraq. Diorhabda carinulata primarily inhabits cold temperate deserts ofMongolia and China west to Russia and south to montane grasslands and warm deserts in southern Iran. Diorhabdameridionalis primarily occupies maritime subtropical deserts of southern Pakistan and Iran to Syria. Northern climatypesof D. carinulata are effective in Tamarix biological control, especially in the Great Basin desert. Diorhabda elongata isprobably best suited to Mediterranean woodlands of northern California. Northern climatypes of D. carinata may be bestsuited for central U.S. grasslands. Diorhabda sublineata, D. meridionalis, and southern climatypes of D. carinata and D. carinulata may each be uniquely suited to areas of the southwestern U.S.
A BLEEDING diathesis has been frequently described in patients receiving multiple transfusions of stored blood but agreement is lacking regarding its pathogenesis and treatment 16, 39, 42 Acquired dilutional thrombocytopenia,15' 25, 27, 30 loss of labile coagulation Factors V and VIII,32,33 fibrinolysis,37 44 and disseminated intravascular coagulation 35 have been suggested as the causes of coagulation defects associated with massive blood transfusions. The lack of agreement may reflect in part the difficulty of systematically studying these often seriously ill patients and separating the effects of transfusion from other factors which may affect coagulation
In this study, the characteristics of 646 patient's primary breast carcinomas, including histologic grade (HG), nuclear grade (NG), mitotic grade (MG), final grade (FG), estrogen receptor (E2R) status, and patient's lymph node status (LN) at the time of surgery were correlated with recurrence-free interval and patient survival in order to determine whether any one parameter or group of parameters serve as adequate predictors of tumor behavior and, therefore, patient's prognosis. The authors' results showed that LN, tumor size, and tumor grade were themselves significant predictors of early recurrence and breast cancer death. Each unit increase in LN or MG increased the risk of death by a factor of 1.5 and 2.0, respectively. However, prediction of time to recurrence or death was considerably more accurate when those parameters were used in conjunction, rather than individually. E2R was also significant in predicting death. MG separated patients within a single LN group or E2R group into two subsets having clinically and statistically different prognoses. It was found that patients who had negative lymph nodes and whose tumors were MG1 had a better prognosis than those with MG2,3 tumors; in these latter patients recurrence and death patterns were similar to those of patients with MG1 tumors having one to three positive lymph nodes. Similarly, whereas patients with four or more positive lymph nodes had bad prognoses, those bearing MG1 tumors tended to behave more like those with MG2,3 tumors and having only one to three positive lymph nodes.
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