Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0268596 (EMA)
 2,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report four previously undescribed primary giant cell tumors of the extrahepatic biliary tree and morphologically compare them with 10 anaplastic spindle and giant cell carcinomas with osteoclast-like giant cells of the gallbladder. Two giant cell tumors were located in the distal common bile duct; one in the cystic duct and one in the gallbladder. The 3 patients with bile duct tumors were male, and the only patient with a gallbladder tumor was a female. The age of the patients ranged from 45 to 60 years with an average of 55 years. The patients with bile duct tumors presented with biliary obstruction, and the patient with a gallbladder tumor presented with symptoms of cholelithiasis and a gallbladder mass. Histologically, the tumors were similar to giant cell tumors of bone. They consisted of a mixture of mononuclear and multinucleated osteoclast-like giant cells. The mononuclear cells showed no atypical features, and their nuclei were similar to those of the multinucleated giant cells. CD163 immunoreactivity was restricted to the mononuclear cells, whereas CD68 and HAM 56 labeled only the multinucleated osteoclast-like giant cells. The mononuclear cells were EMA-positive but did not express cytokeratins. Follow-up showed that 3 patients were alive and disease-free 3.7 to 7 years after surgery. The anaplastic spindle and giant cell carcinomas contained a fewer number of osteoclast-like giant cells, and their mononuclear cells showed considerable variation in size and shape, marked cytologic atypia, and numerous mitotic figures. They were focally cytokeratin positive (AE1/AE3; CAM 5.2) and did not label with CD163, CD68, and HAM 56. The benign osteoclast-like giant cells showed immunoreactivity for CD68 and HAM 56 but were negative for CD163 and cytokeratins. Giant cell tumors of the extrahepatic biliary tree are benign true histiocytic neoplasms that should be distinguished from the highly lethal anaplastic spindle and giant cell carcinomas with osteoclast-like giant cells by detailed cytologic analysis and immunohistochemical stains for CD163, CD68, HAM 56, and cytokeratins.
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PMID:Giant cell tumor of the extrahepatic biliary tree: a clinicopathologic study of 4 cases and comparison with anaplastic spindle and giant cell carcinoma with osteoclast-like giant cells. 1822 38

Antidepressants play the major role in treating depressive patients not only due to the fact that they have to undergo the most rigorous proof of efficacy but also because they are easy to apply in the everyday clinical practice. Nearly all psychiatrists and general practitioners treating depressive patients agree about the relevance of antidepressants in the treatment of depressive patients. However, a number of meta-analytic studies recently challenged this belief and it has been put up for discussion to psychiatry/clinical psychopharmacology whether the efficacy of antidepressants is clinically relevant. Despite that all medication were judged to have sufficient data to receive approval from the FDA and the EMA and other agencies worldwide, some authors went further and questioned the effectiveness of antidepressants. They even proposed that "alternative" therapies of unproven efficacy or of proven negative efficacy should be preferred to medication. These authors do not take into consideration that for methodological reasons it is not acceptable to deduce too extensive conclusions. Some assumptions they rely on, like the suggestion of NICE, which regards a mean placebo-verum difference of 3 HAM-D points as clinically relevant, is downright arbitrary on statistical grounds, and not supported by empirical findings or by expert opinion. It seems that the difference in change in HAM-D score between the active drug and placebo is somewhere between 2 and 3, with maybe some agents performing a little better than others. It is uncertain whether initial severity determines response; different interpretations exist. However, much more important for the evaluation of the clinical relevance is the result of the responder/remitter analysis, which compares the relative frequency of these categories between the placebo and verum groups. This approach results in a number needed to treat (NNT) of 5-7. In evidence-based medicine such a NNT is traditionally regarded as a sign of moderate to strong efficacy and corresponds to the referring values of many therapies, which e.g. are standard therapies in internal medicine. However, from many meta-analyses it is clear that when concepts of evidence-based medicine and health economy are applied, which are far away from clinical thinking, problems occur and results are very difficult to interpret in clinical terms.
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PMID:Problems in determining efficacy and effectiveness of antidepressants. 2227 42