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  • 1
    Keywords: COVID-19 (Disease)-Complications. ; Electronic books.
    Type of Medium: Online Resource
    Pages: 1 online resource (496 pages)
    Edition: 1st ed.
    ISBN: 9789811651052
    DDC: 616.24144
    Language: English
    Note: Intro -- Biography of Prof. Nirmal Kumar Ganguly -- Preface -- Contents -- Editors and Contributors -- About the Editors -- Contributors -- 1: Corona Viruses: Emergence, Evolution, and Recurrence -- 1.1 Introduction -- 1.2 General Classification and Distribution of Corona Viruses (CoVs) -- 1.3 Structural and Genomic Features of Corona Viruses -- 1.3.1 Structural Features -- 1.3.2 Genomic Features -- 1.4 Evolution of Corona Viruses -- 1.4.1 Animal Origin of Human Corona Viruses (HcoVs) -- 1.4.2 Genetic Diversity and Possible Reasons Behind the Interspecies Transmission -- 1.4.2.1 Genetic Diversity Among Human Corona Viruses (HCoVs) -- 1.4.2.1.1 Genus AlphaCoVs -- 1.4.2.1.2 Genus BetaCoVs -- 1.4.2.2 Genomic Variability of Corona Viruses (CoVs) in Animals and Humans -- 1.5 Emergence of Corona Viruses as Human Pathogens -- 1.5.1 Pandemic Human Corona Viruses -- 1.5.2 Endemic Human Corona Viruses -- 1.6 Comparative Pathophysiology of HCoVs -- 1.6.1 Less Pathogenic Strains (229E, NL63, OC43, and HKU1) -- 1.6.2 Highly Pathogenic Strains (SARS-CoV, MERS-CoV, and SARS-CoV-2) -- 1.6.2.1 SARS-CoV -- 1.6.2.2 MERS-CoV -- 1.6.2.3 SARS -CoV2 -- 1.7 SARS-CoV-2 Variants and the Second Wave of COVID-19 -- 1.7.1 Variants of Interest -- 1.7.2 Variants of Concern -- 1.7.3 Surge of COVID-19 in 2021 -- 1.7.4 Second Wave of COVID-19 in Indian Perspective -- 1.8 Therapeutic Options, Control Measures, and Challenges -- 1.8.1 Repurposing of Drugs -- 1.8.2 Control of Corona Viral Diseases Through Vaccines -- 1.8.2.1 Whole Virus Inactivated or Killed -- 1.8.2.2 Live Attenuated Vaccines (LAV) -- 1.8.2.3 DNA Vaccines -- 1.8.2.4 Non-replicating Viral Vector Vaccines -- 1.8.2.5 Protein Subunit Vaccines -- 1.8.2.6 Virus-Like Particle (VLP) Based Vaccines -- 1.8.2.7 RNA Vaccines -- 1.9 Control Measures -- 1.10 Challenges -- 1.11 Conclusions and Future Prospects -- References. , 2: Testing Strategy of Covid-19: A Mechanistic Approach -- 2.1 Introduction -- References -- 3: The Broad Impact of Infectious Disease Epidemics on Human Civilization: A Public Health Perspective -- 3.1 Introduction -- 3.2 Historical Aspects -- 3.2.1 Cholera Forcing -- 3.2.2 Technology Forcing -- 3.2.3 Scapegoating -- 3.2.4 Cholera Denial -- 3.2.5 Role of Globalization -- 3.3 Behavioural Changes in the Wake of COVID-19 -- 3.3.1 International Scenario -- 3.3.2 India/Country-Level Scenario -- 3.3.3 Community-Level Scenario -- 3.3.4 Home-Level scenario -- 3.3.5 Professional Life scenario -- 3.3.6 Health Care Sector scenario -- 3.3.7 Media scenario -- 3.3.8 Behavioural Changes in Routine Life in Various Sections of Society -- 3.3.8.1 Patients -- 3.3.8.2 High-Risk Groups -- 3.3.8.3 Doctors/Nurses/Health Care Workers (Corona Warriors) -- 3.3.8.4 Migrant Labour -- 3.3.8.5 Domestic Help -- 3.3.8.6 Children and Adolescents -- 3.3.8.7 Adults -- 3.3.8.8 Elderly and People with Disabilities -- 3.3.8.9 Scenario in Different Income Groups -- 3.3.8.9.1 Below Poverty Line (Poor People) -- 3.3.8.9.2 Middle-Class people -- 3.3.8.9.3 Upper Middle- and Upper-Class People -- 3.3.9 Impact on Different Aspects of the Life of the General Public -- 3.3.9.1 Home -- 3.3.9.2 Food -- 3.3.9.3 Shopping for Grocery -- 3.3.9.4 Entertainment -- 3.3.9.5 Work/Offices/Occupation -- 3.3.9.5.1 Permanent Employees -- 3.3.9.5.2 Loss of Job for Temporary Workers, Future Gloomy -- 3.3.9.5.3 Hospitality Industry -- 3.3.9.5.4 Conferences, Meeting, Interviews/Exams and Outings were Suspended -- 3.3.9.5.5 Work from Home -- 3.3.9.5.6 School/Colleges -- 3.3.9.5.7 Outing/Socializing -- 3.3.9.5.8 Marriages/Rituals/Functions/Ceremonies -- 3.3.9.5.9 Sleep -- 3.3.9.5.10 Mental Health Issues -- 3.3.9.5.11 Exercise -- 3.3.9.5.12 Transport and Travel -- 3.3.9.5.13 Rent/Accommodation. , 3.3.9.5.14 Health care sector -- 3.3.9.5.15 Pets -- 3.3.9.5.16 Religious Places -- 3.3.10 Behavioural Economics and COVID-19 -- 3.3.11 COVID-19 Resulted in Unprecedented Job Loss -- 3.3.12 Social Impacts: Rumours and social chaos -- 3.3.13 The Pandemic Brought us Many Gains Also- -- 3.4 Role of Various Stakeholders in Corona Pandemic with a Specific Focus upon Public Health Discipline -- 3.4.1 Role of National-Level Policy-Makers/Executives/Experts -- 3.4.2 Role of Apex-Level Medical Institutions -- 3.4.3 Role of Public Health Professionals in Control of Coronavirus Crisis -- 3.4.4 Application of General Principles of Public Health -- 3.4.4.1 Level 1: Health Promotion -- 3.4.4.1.1 Ways to Improve our Societies After the Pandemic -- 3.4.4.1.2 Common-Sense Steps cities Can Take to Fight the Coronavirus -- 3.4.4.1.3 Ways to Tackle Ethical and Legal Issues in Pandemic Planning (Lemon et al. 2007) -- 3.4.4.1.4 Application of the Other Lessons Learnt -- 3.4.4.1.5 Battling Airborne Pathogens -- 3.4.4.1.6 Vaccines and Pharmaceuticals -- 3.4.4.2 Level 2: Specific Protection -- 3.4.4.3 Secondary Prevention (Level 3: Early Diagnosis and Treatment) -- 3.4.4.4 Tertiary Prevention -- 3.4.5 Public Health Professionals´ Perspectives on COVID-19 -- 3.5 Conclusions and Recommendations -- 3.5.1 Behavioural Strategies for Disease Containment and Mitigation -- 3.5.2 The Problem of Authority Needs to Be Resolved -- 3.5.3 Role of the Government and the Administrators -- 3.5.3.1 Widespread Blame Games -- 3.5.3.2 Impact of Shutdowns -- 3.5.3.3 Pandemic as an Opportunity for `Technology Forcing´ -- 3.5.3.4 One Health Concept -- 3.5.3.5 Pandemics as Collateral Damage of our Behaviour -- 3.5.3.6 Pandemics Viewed as a By-Product of International Power Game -- 3.5.3.7 Final Comments -- References -- 4: Human Impacts on Natural Habitats Leading to Covid-19 Pandemic. , 4.1 Introduction -- 4.2 Human Impacts on Natural Habitats -- 4.3 Unplanned Urbanization -- 4.4 Climate Change -- 4.5 Environmental Sustainability for the Prevention of Pandemics in Future -- 4.6 Conclusion -- References -- 5: Transmission of SARS-CoV2 and Strategies for Control of Infection: Lessons Learnt -- 5.1 Introduction -- 5.2 Modes of Transmission -- 5.2.1 Epidemiological Triad of COVID-19 -- 5.2.2 Chain of Transmission -- 5.2.3 Incubation Period -- 5.3 Phases of Pandemic -- 5.4 Strategies to Break the Transmission of SARS-CoV-2 -- 5.5 Impact of Various Strategies on Different Spheres of People -- 5.6 Mortality and Comorbid Conditions Associated with COVID-19 -- 5.7 Role of Vaccine -- 5.8 Success Stories -- References -- 6: Pathogenesis of COVID-19 Infection -- 6.1 Introduction -- 6.2 Virus Entry and Spread -- 6.3 Cytokine Storm -- 6.4 Acute Respiratory Distress Syndrome (ARDS) -- 6.5 Immune Dysfunction -- References -- 7: Pathology of COVID-19 Infection -- 7.1 Introduction -- 7.2 The Pulmonary System -- 7.3 Extra Pulmonary Involvement -- 7.3.1 The Cardiovascular System -- 7.3.2 The Nervous System -- 7.3.3 Musculoskeletal System -- 7.3.4 The Liver -- 7.3.5 The Kidney -- 7.3.6 The Gastrointestinal System -- 7.3.7 The Skin -- 7.3.8 The Genital System (Testis) -- 7.3.9 The Hematopoietic System -- References -- 8: COVID-19: Clinical Spectrum-It´s Multiorgan Syndrome -- 8.1 Introduction -- 8.2 Clinical Presentation -- 8.2.1 Pulmonary Manifestations -- 8.2.2 Extrapulmonary Manifestations -- 8.2.2.1 Gastrointestinal and Liver -- 8.2.3 Renal Manifestations -- 8.2.4 Cardiac Manifestations -- 8.2.5 Vascular System -- 8.2.6 Neurologic Manifestations -- 8.2.7 Hematologic Abnormalities -- 8.2.8 Cutaneous Manifestations -- 8.2.9 Reproductive System Involvement -- 8.2.10 Ocular Manifestations -- 8.2.11 Psychiatric Manifestations -- 8.3 Special Considerations. , 8.3.1 COVID-19 and Pregnancy -- 8.3.2 COVID-19 and Children -- 8.4 Conclusion -- References -- 9: Organ Involvement in COVID 19: Lung and Beyond -- 9.1 Introduction -- 9.2 Lung Involvement -- 9.3 Heart and Blood Vessels -- 9.4 Gastrointestinal Tract and Liver -- 9.5 Haematological Manifestations -- 9.6 Neurological Manifestations -- 9.7 Anosmia and Ageusia -- 9.8 Renal Involvement -- 9.9 Skin Manifestations -- 9.10 Endocrine Abnormalities -- 9.11 Ocular Manifestations -- 9.11.1 Persistent/Long COVID -- Suggested Reading -- 10: COVID-19 and Mucormycosis -- 10.1 Introduction -- 10.2 Mucormycosis -- 10.3 COVID-19 and Immunosuppression -- 10.4 Mucormycosis Coinfection in COVID-19 -- 10.5 Time of Presentation -- 10.6 Reasons for Increase in Mucormycosis in COVID-19 patients (https://dghs.gov.in/WriteReadData/News/202105171119301555988Mu... -- 10.7 Diagnosis -- 10.8 Current Management and Treatment Options for CAM -- References -- 11: Rhino-Orbito-Cerebral Mucormycosis-The Bane of the `Black Fungus´ -- 11.1 Introduction -- 11.2 Cause and Pathogenesis -- 11.3 Risk Factors -- 11.4 COVID-19 and Mucormycosis -- 11.5 Clinical Features of Rhino-Orbito-Cerebral-Mucormycosis -- 11.6 Imaging -- 11.7 Microbiological Investigations -- 11.8 Management -- 11.8.1 Medical Management -- 11.8.2 Surgical Management -- 11.8.3 Systemic Management -- 11.9 Disease Burden and Prognosis -- 11.10 Prevention -- 11.11 Conclusion -- References -- 12: Strokes, Neurological, and Neuropsychiatric Disorders in COVID-19 -- 12.1 Introduction -- 12.2 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) Infection -- 12.3 The Burden of Neurological Manifestations -- 12.4 Pathogenesis of Neurological Manifestations in COVID-19 -- 12.5 Stroke in COVID-19: Risk Factors, Pathogenesis, and Clinical Manifestation -- 12.6 Neuropsychiatric Manifestations of COVID-19 -- 12.7 Summary. , References.
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  • 2
    ISSN: 1436-2813
    Keywords: esophageal web
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A circumferential web was located in the proximal portion of the esophagus in a 69 year old female who was admitted to the Iwate Medical University Hospital with severe chronic dysphagia. She had a long history of difficulty in swallowing, intermittently and primarily associated with the ingestion of solid foods. The web was easily ruptured upon endoscopy with subsequent bouginage being performed twice leading to the complete relief of dysphagia. However, dysphagia recurred 6 months postbouginage and the circumferential web, which had regenerated, had less distensibility, making re-dilation impossible. Surgery was elected which revealed esophageal obstruction by a firm circumferential structure. Microscopic examination of the excised web revealed it to consist of a transverse fold of the esophageal mucosa with chronic inflammatory changes and submucosa with marked fibrous tissue proliferation. The patient has remained asymptomatic for the 4 years following her operation.
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  • 3
    ISSN: 1436-2813
    Keywords: benign esophageal stricture ; Barrett's esophagus ; fundic patch operation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 66-year-old woman, who had a stricture of the distal esophagus with Barrett's epithelium caused by gastroesophageal reflux, was operated upon by means of the fundic patch method. Preoperative manometric and pH studies revealed that the patient had a cardiac incompetence and a delayed acid clearance of the esophagus. Endoscopic biopsies between 33–35 cm from the incisors, above the gastroesophageal junction, showed columnar metaplasia with a villiform surface, mucous glands, intestinal goblet cells, moderate inflammatory changes and focal mild dysplasia. After the operation, relief of the dysphagia and reflux symptoms were obtained successfully, and an endoscopy done 7 months later demonstrated that the esophageal lumen was adequate enough for passage, and that there was improvement of the esophagitis, though persistent Barrett's esophagus without malignancy still existed. These results indicate that the fundic patch operation with the formation of a mucosal valve and 270° fundoplication is a useful method of choice for benign strictures of the lower esophagus.
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  • 4
    ISSN: 1436-2813
    Keywords: diffuse esophageal spasm ; fundic patch procedure ; esophageal myotomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A diagnosis of diffuse esophageal spasm (DES) based on radiological and manometric studies was made in a 70-year-old man who presented with severe dysphagia, vomiting, and spontaneous chest pain. The manometric studies revealed a simultaneous onset of high amplitude contractions and a hypertensive lower esophageal sphincter (LES) that was well relaxed in response to deglutition, in contrast to the incomplete relaxation seen in achalasia. Because his dysphagia was so severe and did not respond to pneumatic dilatation, the patient was treated by a long esophageal myotomy with a full thickness incision through the LES and mucosa, adding a Thal-Hatafuku procedure. The patient made a good postoperative recovery and has since been eating normally without any further dysphagia or chest pain. Good manometric and radiological results have been obtained in this patient during 5 years of follow-up.
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  • 5
    ISSN: 1436-2813
    Keywords: endotoxin ; portal endotoxemia ; esophageal varices
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Under the hypothesis that portal endotoxemia, which has been considered evidence of endogenous endotoxemia, is actually a false-positive reaction of the Limulus test, the conventional method of determination, Toxicolor (TOX) and a new endotoxin-specific method, Endospecy (ES) were investigated, whereby portal endotoxemia was reexamined. Peripheral and portal blood samples were collected from 12 patients at various intervals during surgery for esophageal varices, and then evaluated by TOX and ES, the normal values of which are under 60.0 pg/ml and under 9.8 pg/ml, respectively. The mean peripheral and portal endotoxin (Et) levels by TOX were 23.1 pg/ml and 38.9 pg/ml, 1.5 h after the start of surgery, which continued to increase thereafter, the corresponding levels being 48.1 pg/ml and 58.7 pg/ml 8 h after the start of surgery, respectively. The portal Et levels were significantly higher by ES, indicating portal endotoxemia, the mean peripheral and portal Et levels being 6.9 pg/ml, and 6.5 pg/ml, 1.5 h after the start of surgery, these levels showing changes within a similar range. The levels determined by the conventional TOX method increased with time, to a portal Et level of 5.0 pg/ml 8 h after the start of surgery, whereas those determined by ES changed within the same range suggesting that the onset of portal endotoxemia primarily involves the G-factors and that endogenous endotoxemia does not occur.
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  • 6
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Nous présentons les résultats obtenus, chez 10 malades, par notre nouvelle technique d'oesogastrostomie avec valvuloplastie pur la prévention de l'oesophagite par reflux postopératoire. Après résection de la partie proximale de l'estomac, la partie interne de la tranche de section gastrique est suturée de la manière habituelle. La muqueuse de la partie externe est partiellement fermée, mais la séromusculeuse est laissée ouverte. L'oesophage est anastomosé à la muqueuse du moignon gastrique, et cette suture est invaginée pour former la valve muqueuse. La couche séromusculaire vient ensuite entourer l'oesophage distal, comme dans une fundoplicature à la Nissen, pour former une nouvelle poche à air. La paroi oesophagienne, en position intragastrique dans la nouvelle poche à air, forme une longue valve unidirectionnelle qui s'oppose au reflux. Les 10 malades qui ont subi cette oesogastrostomie avec valvuloplastie n'ont présenté aucune complication attribuable au reflux. Les examens radiologiques et endoscopiques au moment de la sortie n'ont montré ni reflux, ni oesophagite. Chez 5 malades, des mesures de pH faites de long de l'anastomose et de la valve révèlent une brusque élévation de pH au moment où l'électrode atteint le niveau de la suture. Chez 7 malades, des mesures de pression au même endroit montrent une zone de pression élevée (en moyenne 11.3 mm Hg sur une hauteur moyenne de 4.0 cm). Ces résultats indiquent que cette nouvelle technique d'oesogastrostomie est efficace dans la prévention de l'oesophagite par reflux après gastrectomie proximale conventionnelle.
    Notes: Abstract This is a report of our new method of valvuloplastic esophagogastrostomy for the prevention of postoperative reflux esophagitis, and the clinical results in 10 patients. After proximal resection of the stomach, the medial side of the cut end of the gastric remnant is closed in the usual fashion. The mucosal layer of the lateral side of the gastric remnant is partially closed, but the seromuscular layers are left open. The esophagus is anastomosed to the gastric remnant mucosa, which is inverted so as to form a mucosal valve. The seromuscular layers of the gastric remnant are then wrapped around the distal esophagus, similar to a Nissen fundoplication, so as to create an artificial fundus. The intragastric esophageal wall facing the fundus acts as a long oneway flap valve to prevent reflux. The 10 patients who have undergone valvuloplastic esophagogastrostomy have remained free of postoperative complications due to reflux. X-ray fluoroscopy and esophagoscopy done at the time of discharge from the hospital revealed no evidence of reflux or esophagitis. Withdrawal pH studies performed in 5 of the patients showed a sharp rise in pH starting at the site of the anastomosis. Withdrawal intraluminal pressure studies performed in 7 patients showed a high pressure zone with a mean pressure of 11.3 mm Hg and a mean length of 4.0 cm. These results indicate that the new method of esophagogastrostomy effectively prevented postoperative reflux esophagitis after conventional methods of proximal gastric resection.
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  • 7
    ISSN: 1432-0851
    Keywords: Monoclonal antibodies ; Small-cell lung cancer ; Synergy of mAb binding
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Murine IgG1 monoclonal antibodies (mAbs), ITK-2 and ITK-3, were generated against a small-cell lung cancer (SCLC) cell line. Enzyme-linked immunosorbent assay using a variety of established cell lines as substrates, immunoperoxidase staining of freshly frozen tissue sections, and fluorescence-activated cell sorter analysis of peripheral blood leukocytes showed that these mAbs recognize a part of the SCLC-associated cluster 1 antigen. In immunoprecipitation studies, both ITK-2 and ITK-3 bound to a 145-kDa glycoprotein of SCLC cell membrane extracts, as did MOC-1 and NKH-1, which both recognize the cluster 1 antigen. However, because the binding of125I-labeled ITK-2 to SCLC cells was not inhibited by MOC-1 or NKH-1, the binding site of ITK-2 on SCLC cells appeared to be different from that of either MOC-1 or NKH-1. Unexpectedly, binding of125I-labeled ITK-2 to SCLC cells increased in the presence of ITK-3. This ITK-3-induced increase in ITK-2 binding was due partly to an increase in the number of binding sites for ITK-2 on SCLC cells. Addition of ITK-3 may, therefore, improve the effectiveness of ITK-2-based tumor detection or therapy.
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  • 8
    ISSN: 1432-2307
    Keywords: Key words Breast neoplasms ; Malignant myoepithelioma ; Metastasis ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A breast tumor in a 52-year-old female was interpreted as a malignant myoepithelioma based on morphological and immunohistochemical studies. The tumor consisted of elongated cells with clear cytoplasm and lacked glandular components. The tumor cells were stained positively for keratin, S-100 protein, glial fibrillary acidic protein (GFAP) and muscle-specific actin. Distant metastasis in the right jaw developed 8 years after the initial surgery and the metastatic deposit showed a similar morphology and immunoreactivity. Myoepithelial tumors are generally considered as benign or low-grade lesions and distant metastasis has been rarely documented. The present case presents the possibility of delayed occurrence of distant metastasis in myoepithelial tumor of the breast.
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  • 9
    ISSN: 1615-2573
    Keywords: Tissue plasminogen activator ; Alteplase ; Cerebral bleeding ; Sudden death
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We describe an autopsy case of severe intracranial hemorrhage which occurred during the infusion of tissue plasminogen activator (t-PA) for acute myocardial infarction. A 75-year-old man was admitted with substernal chest pain of 3-h duration and elctro-cardiographic changes consistent with an acute inferior myocardial infarction. Physical examination was unremarkable, except for an initial blood pressure reading of 160/96 mmHg. The patient received 3,000 IU intravenous heparin followed by a 2.4 × 106 IU bolus dose of tissue plasminogen activator (t-PA) (Alteplase). This was followed by a drip infusion of 21.6 × 106 IU of t-PA over 1 h (total dose 41 mg). Thirty minutes after the infusion of t-PA was initiated, the patient suddenly lost consciousness and began to have violent convulsions, followed by cardiac arrest. Autopsy revealed massive hemorrhage in the bilateral cerebrum and brain stem. To our knowledge, this is the first case of sudden death during t-PA infusion therapy.
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  • 10
    ISSN: 1573-7373
    Keywords: recurrent meningioma ; micronecrosis ; p53 ; p21WAF1/CIP1
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recurrence is an important factor for prognosis of meningioma patients, this also occurring with some lesions diagnosed histopathologically as benign. To analyze their relationships with clinicopathological factors, p53 and p21WAF1/CIP1 immunoreactivity, 80 meningiomas were classified into four groups with regard to the World Health Organization (WHO) histological classification and recurrence: 40 cases of Group I (typical type)-NR (no recurrence); five cases of Group I-R (recurrence); 20 cases of Group II (atypical or anaplastic type)-NR and 15 cases of Group II-R. Micronecrosis was detected in 25% of Group II-NR and 73.3% of Group II-R (P=0.007, odds ratio (OR) =8.25, 95% confidence interval (CI) =1.79–38.01). Patients receiving radiation therapy had a lower risk of recurrence (P=0.041, OR =0.20, 95% CI =0.05–0.85). Immunoreactivity for p53 protein was positive in 22% of Group I and 54% or Group II (P=0.005), and in 80% of Group I-R and 15% of Group I-NR (P=0.006, OR = 22.7, 95% CI = 2.15–239.4). p21WAF1/CIP1 protein was detected in 22% of Group I and 48% of Group II (P=0.017), but with no link to recurrence. Multivariate analysis also showed p53 immunoreactivity in Group I (benign lesions) and micronecrosis in Group II (atypical/anaplastic meningiomas) to be strong prognostic factors for recurrence (P〈0.05). These results indicate that p53 immunoreactivity and micronecrosis can help predicting recurrence of meningiomas.
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