Comparison of outcomes and donor-site morbidity in unilateral free TRAM versus DIEP flap breast reconstruction.

BACKGROUND: At long-term follow up we cannot easily differentiate between patients who have undergone free transverse rectus abdominis musculocutaneous (TRAM) flap and deep inferior epigastric artery perforator (DIEP) flap breast reconstruction in terms of subjective functional limitations of daily activities. The aim of this study was to evaluate postoperative outcomes and long-term subjective functional deficit in patients following unilateral free TRAM compared with DIEP flap breast reconstruction. METHODS: Sixty consecutive patients who underwent unilateral autologous breast reconstruction were included in the study, 30 of whom had undergone a DIEP flap, and 30 a free TRAM flap. Surgical and postoperative outcome data were collected and a postal questionnaire was sent to each patient at least 6 months postoperatively consisting of a short functional assessment questionnaire and a Short Form 36 (SF-36) survey. RESULTS: We found no significant difference in postoperative outcomes or in the subjective ability to perform activities of daily living, including work, domestic activities, sports and hobbies, between patients who underwent TRAM flap breast reconstruction and those who underwent a DIEP flap, and no significant difference between the groups for scores on the physical functioning, role-physical, or bodily pain scales of the SF-36. CONCLUSION: We conclude that harvesting of the free TRAM flap results in no significant difference in postoperative outcomes or in the subjective ability to perform activities of daily living compared with the DIEP flap.     

Role of the IGF axis in prostate cancer

The major issue currently being faced in the management of prostate cancer is the inability to distinguish between indolent prostate tumors that will not present clinically from more aggressive and metastatic prostate cancers that will impact on men's lives. Only a small proportion of prostate cancers can be accounted for by unmistakable hereditary cancer syndromes and the predominant contribution to the progression of most sporadic cancers is thought to be environmental, with nutrition having the greatest influence. Population studies have clearly implicated metabolic factors as contributors to disease progression and poor response to therapy. It is well established that the IGF system is key in regulating growth and metabolism and mediates the effects of nutrition on these processes. It consists of two ligands (IGF-I and IGF-II), two receptors [type 1 IGF-IR and IGF-II/mannose 6-phosphate receptor], and six high affinity IGF-binding proteins (IGFBP-1 to -6). This review provides evidence from in vitro, in vivo, clinical and epidemiology studies that indicates an important role for the IGF axis in the development of prostate cancer and the likely role that it plays in mediating the effects of nutrition on disease progression. We suggest that the IGF axis is central to understanding how lifestyle impacts on prostate cancer and we highlight this by describing numerous strategies being developed to target this axis.     

The pulmonary neuroendocrine system and drainage of the fetal lung: effects of serotonin

The neuroendocrine system of the lungs is maximally developed and activated at birth, but has no clear function. Here, one of its products, serotonin, was tested for an ability to stop lung fluid production or activate reabsorption. Lungs from fetal guinea pigs (61 +/- 2 days of gestation) were supported in vitro for 3 h; lung liquid production was monitored by a dye dilution method. Initial studies on 36 young fetuses (61 +/- 1 days of gestation) showed that untreated controls produced fluid at 1.17 +/- 0.23 ml.kg-1.h-1, with no significant change over 3 h (ANOVA; regression analysis); those given 10(-8) M serotonin during the middle hour showed no significant changes, but those given 5 x 10(-8), 10(-7), 10(-6), or 10(-5) M serotonin reduced production significantly (P < 0.01 to P < 0.0005). Responses were linear up to 10(-7) M (threshold, 10(-9) M) and then become maximal at 50% reduction. However, responses increased with age. Comparison of 40 fetuses divided into groups of 60-61 or 65-67 days of gestation showed a large and significant increase in responses in the older fetuses (P < 0.01), where half the preparations reabsorbed fluid. Serotonin receptors were involved, since 10(-6) M cyproheptadine abolished responses (based on 24 preparations). Amiloride-sensitive Na+ channels were involved, since 10(-6) M amiloride abolished responses (based on 24 preparations). These results, in combination with earlier results from somatostatin and dopamine, together with histochemical and clinical observations, strongly suggest that the neuroendocrine system of the lungs may find a function in clearing fluid from the lungs at time of birth.     

Increased p53-dependent apoptosis by the insulin-like growth factor binding protein IGFBP-3 in human colonic adenoma-derived cells

We investigated the expression of insulin-like growth factor binding protein 3 (IGFBP-3) in normal human colonic epithelium and whether IGFBP-3 is involved in the induction of apoptosis in colonic epithelial cells. A gradient of IGFBP-3 protein expression was observed within the normal colonic crypt, and increased IGFBP-3 expression was coincident with the region of increased differentiation and apoptosis. Treatment of human colonic tumor cell lines with IGFBP-3 alone was shown to have no effect on growth. However, an increase in p53-dependent apoptosis was observed in the presence of 100 ng/ml IGFBP-3 24 h after the induction of DNA damage by gamma-irradiation. These results suggest that IGFBP-3 enhances the p53-dependent apoptotic response of colorectal cells to DNA damage.     

Comparative studies of plasma kinins: The kallikrein-kinin system in poikilotherm and other vertebrates

Plasma kinins were studied throughout a wide-range of vertebrates. In all mammals, birds, and reptiles investigated, trypsin liberated kinins from whole blood preparations, from heat-treated plasma, and from intact plasma treated with 8-HQSO₄ (overall range of kinins = 0.7–4.4 μg/ml plasma, BK-equivalent). Trypsin failed to produce kinins from similar preparations of amphibian, teleost, holocephalian, and elasmobranch blood, except for traces of activity in heat-treated amphibian plasma. A glass surface generated kinins in mammalian and turtle plasmas (averages: rat, 2.5; dog, 1.6; turtle, 1.3 μg/ml plasma, BK-equivalent); however, it was apparently without effect on any amphibian or teleost plasma tested. Kininase activity was found throughout all vertebrate plasmas investigated. The results suggested that plasma kinins could exist in the blood of various reptiles, birds, and mammals, and that a glass-activatable kallikrein-kinin system was present in the mammals and the turtle. A kinin-generating system could not be demonstrated in fish and amphibian plasmas. However, hog pancreas kallikrein liberated an oxytocic agent from the heattreated plasmas of fish and amphibians, as well as from all other vertebrate plasmas; the highest activity was found in the urodele, Amphiuma tridactylum (2.9 μg/ml plasma, BK-equivalent). Therefore, despite the apparent absence of the classical kallikrein-kinin system, oxytocic agents with some similarities to kinins can be produced in lower vertebrate plasmas by the action of specific kallikreins.     

Malignant perivascular epithelioid cell tumour ("PEComa") of soft tissue: a unique case

Tumours of perivascular epithelioid cells (PEComas) are being increasingly reported at visceral and somatic sites. Both benign and malignant variants have been identified, although clinical follow-up is often limited, which prevents meaningful predictions of behavior. We report the case of a malignant soft tissue PEComa with histologically confirmed regional lymph node metastases and radiologically confirmed pulmonary metastases. The light microscopic appearance and immunohistochemical profile (HMB-45, smooth muscle actin positive) and electron microscopic appearance support perivascular epithelioid cell differentiation.