Wound healing in forefoot amputations: The predictive value of toe pressure

A retrospective study of 136 men undergoing forefoot amputation was done to test the hypothesis that preoperative toe pressure (TP) could predict the likelihood of wound healing. Demographic data included age, smoking history, diabetes mellitus (DM), hypertension, hyperlipidemia, and coronary artery disease. Clinical data included infection, preoperative arterial Doppler data, TP, wound disposition, concomitant revascularization (REV), and healing outcome. Among diabetics, no primary amputation healed with a preoperative TP <38 mm Hg. Among REV diabetics, no healing occurred with a TP <40 mm Hg after bypass, but no failures occurred either with a TP >68 mm Hg or an increase in TP >30 mm Hg after bypass. Nondiabetic patients exhibited no threshold TP values. Univariate analysis revealed that DM and REV were significantly different in the healed (N=83) vs. nonhealed (N=53) populations ( p =0.027 and 0.034). In healed patients, mean TP (71.8 ± 3.5 mm Hg SEM) was significantly higher than in nonhealed patients (45.1 ± 4.3 mm Hg SEM,p =0.000). Logistic regression analysis identified age >60 years (p =0.03), DM (p =0.003), preoperative TP ( p <0.001), and REV ( p <0.001) as significant independent predictors of forefoot amputation healing. Healing probability was calculated and plotted vs. TP for subpopulations based on age, DM, and REV status for both primary forefoot amputation and amputation concomitant with bypass. In this study population, therefore, preoperative TP appeared to be a useful clinical tool for predicting the healing potential of both primary forefoot amputations and amputations plus concomitant bypass for any given patient.     

Biocompatible heterogeneous porous gel matrix NeuroGelTM promotes regeneration of rat sciatic nerve within tubular silicone prosthesis (experimental study)

Background

The purpose of this study was to investigate the ability of NeuroGel? to promote and enhance the regeneration of rat sciatic nerve within a 10-mm gap using silicone tubular prosthesis, and to evaluate and compare the regeneration outcomes versus autologous grafting.

Methods

The 10-mm gap of rat sciatic nerve was bridged through silicone tubular prosthesis filled with dehydrated NeuroGel?, and NeuroGel? saturated with rat NGF-B (NG30-NGG60, NGgfB30-NGgfB60). To assess the regeneration of the peripheral nerve we utilized three general and most commonly applied methods: electrophysiologic, hystomorphometric, and functional methods.

Results

The average M-wave amplitude (A_MW index), or the intermediary index of the number of regenerated axons, in animal groups NGG60 and NGgfB60 60 days post-op was: 2.44?±?0.57 mV and 1.87?±?0.48 mV. These indices were statistically lower compared to the indices obtained after autologous grafting. The average impulse conduction velocity along motor fibers (V_MF index), or the intermediary index of myelination rate, was: 13.3 mm/ms and 13.3 mm/ms, respectively, statistically equal to indices obtained after autologous grafting. The average density (D) of regenerated fibers (direct numerical indicator in contrast to intermediary A_MW index) in animal groups NGG60 and NGgfB60 was: 4,920?±?178.88 and 5,340?±?150.33 per mm², respectively. These indices were statistically higher versus indices obtained after autologous grafting. Myelination rates of regenerated fibers in animal groups NGG60 and NGgfB60 were 73 and 86 %, respectively. They were also statistically higher. The average sciatic functional index (SFI) in NGG60 and NGgfB60 was: ?25.57?±?3.05 and ?24.124?±?4.8, respectively, which is statistically equal to indices obtained after autologous grafting.

Conclusions

Neurogel? strongly promotes the regeneration of rat sciatic nerve within silicone tubular prosthesis. After bridging a 10-mm gap through silicone prosthesis with Neurogel? or Neurogel? +NGF-B-modified intraluminal space, the myelination rate of regenerated axons of rat sciatic nerve appeared to be higher, and the axon count and functional recovery is similar to results seen with the autografting technique.     

BiClamp forceps significantly shorten the operation time for breast surgery

Purpose

A novel approach was introduced for breast surgery using the BiClamp, a new bipolar thermal energy device, to avoid complications and to shorten the time required for the dissection of the axillary lymph nodes.

Methods

Thirty-six patients with early breast cancer were assessed. The surgical parameters were compared between the procedures performed using the BiClamp technique (n = 14) and conventional surgery with suture ligation (n = 22). The parameters included the operation time, blood loss, and discharge on the first postoperative day. In addition, each of those parameters was compared between the patients with a high body mass index (BMI) (>22) and a low BMI (≤22). The sealed vessels were examined histologically and heat-associated morphological vessel wall alterations were evaluated.

Results

The operation time was significantly shorter in the BiClamp group than in the control group (P = 0.017, 90 ± 18 vs 115 ± 33 min). In addition, the blood loss in the BiClamp group tended to be smaller than in the control group, but the difference was not significant (P = 0.54, 61 ± 47 vs 74 ± 67 g). No other parameters showed any significant differences between the two groups.

Conclusion

The BiClamp thermofusion technique was safe and useful in breast surgery involving axillary dissection.     

Fixed and functional decentering of the head of the humerus in patients with omarthrosis

Aim: To determine whether in patients with specific types of osteoarthritis of the shoulder not only a fixed but also a functional decentering of the humeral head exist. Method: The shoulder joints of 10 healthy volunteers and of 16 patients with osteoarthritis of the shoulder were examined in various arm-positions, using an open MR scanner. After segmentation, 3D reconstruction of the scapula and humerus were performed and the position of the midpoint of the humeral head calculated relative to the center of mass of the glenoid cavity. Results: At 30° of abduction, 4 of 16 patients demonstrated a fixed posterior (12.9±2.8 mm) position and 8 (all patients with cuff-arthropathy) a fixed superior (6.6±2.6 mm) position of the humeral head. At 90° of abduction the patients showed a significant (p<0.001) combined decentering in the superior and posterior direction as compared to the healthy shoulders (functional decentering). Conclusions: This study demonstrates, that in most of the patients with osteoarthritis of the shoulder, a significant functional decentering occurred during abduction and external rotation, even if they showed no fixed decentering of the humeral head at 30° of abduction.     

Removal of the infrapatella fat pad during total knee arthroplasty: does it affect patient outcomes?

Purpose

The function of the infrapatella fat pad (IFP) is debated, but it is thought to have a biomechanical and biological role. Removal of the IFP during total knee arthroplasty (TKA) remains a matter of surgeon preference. This study sought to establish if removal of the IFP during TKA affected patient outcome.

Methods

Excision of the IFP (not removed, partially excised, or fully excised) and outcome data (Oxford knee Score (OKS) and EQ-5D) were recorded for 1,401 patients (1,417 TKA). There were no differences in the pre-operative scores between the groups.

Results

OKS and EQ-5D one-year postoperatively demonstrated significantly (p?ANOVA) improved total scores with preservation of the IFP. Patients with the IFP preserved had significantly better OKS associated with rising from a chair, pain, limping, giving way, and pain interfering with work.

Conclusions

This study suggests that preservation of the fat pad during TKA is associated with improved outcome. Surgeons routinely undertaking excision of the IFP should reflect whether this is clinically indicated and consider limiting IFP resection, if possible.     

Relationships of Na+ and K+ concentrations to GRP,CGRP, and calcitonin immunoreactivities and Na+,K+-ATPase (NKA) inhibitory activity in human breast cyst fluid

Background: Although the etiology of gross cystic disease of the breast is unknown, elevated cyst concentrations of potassium (K⁺) (>60 mM/L) may be related to symptoms. The purpose ofthis study was to clarify the mechanism(s) of K⁺ accumulation in breast cysts. Methods: We assayed cyst fluids for factors known to exert effects on K⁺ transport, namely, endogenous digitalis-like inhibitors of Na⁺,K⁺-ATPase (NKA) and the neuropeptides gastrin-releasing peptide (GRP), calcitonin (CT), and calcitonin gene-related peptide (CGRP). Results: Cyst fluid K⁺ was directly correlated with cyst volume, cyst NKA inhibitory activity (in ouabain equivalents), and cyst concentrations of calcitonin, GRP, and CGRP. Cyst fluid Na⁺ was inversely correlated with cyst fluid K⁺, cyst NKA inhibitory activity, cyst volume, and cyst fluid concentrations of calcitonin, GRP, and CGRP. NKA inhibitory activity correlated directly with GRP and CGRP. Immunocytochemistry localized GRP to breast cyst lining cells and areas of ductal and lobular epithelial hyperplasia in biopsies of 15 of 15 cysts and in 5 of 5 breast carcinomas, but not in (0 of 5) normal breast biopsies. Specificity of GRP staining was demonstrated by total abolition of reactivity after adsorption with synthetic GRP, but not after adsorption with synthetic substance P, neurokinin A, or neurokinin B. Conclusions: We conclude that both the concentrations of endogenous digitalis-like factors and the neuropeptides calcitonin, GRP, and CGRP in human breast cyst fluids are related to the concentrations of K⁺ and Na⁺ in breast cysts and to cyst volume.     

Prognostic significance of occult lymph node metastases in node-negative breast cancer

Background: Lymph node status, established by a single hematoxylin and eosin (H&E) section from each node, remains an important prognostic indicator in patients with breast cancer, but used alone it is insufficient to identify patients who will develop metastatic disease. This study was conducted to assess the significance of detecting occult metastases in 86 patients with breast cancer originally reported to be histologically node negative. None of the patients received adjuvant systemic therapy. Methods: Five additional levels from formalin-fixed, paraffin-embedded nodes were examined at 150-μm intervals with H&E staining and a cocktail of antikeratin antibodies (AE1/AE3) recognizing low molecular weight acidic keratins. Results: Nodes from 11 (12.8%) of 86 patients contained occult metastases. All metastases identified by cytokeratin antibody were also detected in H&E-stained sections. With median follow-up of 80 months, distant metastases occurred in five of 11 occult node-positive patients (45%) and 13 of 75 patients whose nodes were negative on review (17%). Median time to recurrence was 89 months for occult node-positive patients and not yet reached for node-negative patients (p=0.048). The disease-specific 5-year survival rate was 90% for occult node-positive patients and 95% for node-negative patients. Conclusions: The presence of occult metastases shortened the disease-free interval and suggested that more diligent axillary staging would more accurately identify patients who would benefit from systemic adjuvant treatment. Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

Limited surgical management for primary breast cancer: A commentary on the NSABP reports

This report presents an overview of findings from 2 interrelated studies carried out during the past 15 years by the National Surgical Adjuvant Breast and Bowel Project to determine the efficacy of alternative local and regional treatments of primary breast cancer. Findings from the first clinical trial, begun in 1971 involving 1,665 women, indicate that after 10 years of follow-up there are no significant differences in disease-free survival, distant disease-free survival, or survival among patients treated by radical mastectomy or total mastectomy with and without radiation. The findings also indicate that radiation of internal mammary nodes in patients with inner quadrant lesions does not improve survival and that results obtained at 5 years accurately predict the outcome through 10 years. The second clinical trial, implemented in 1976 and accruing 1,843 women, demonstrates that after 5 years, treatment by segmental mastectomy (lumpectomy) with or without radiation results in disease-free, distant disease-free, and overall survival at least equivalent to, and in certain aspects better than, that achieved after total breast removal. Whereas 92% of those treated with radiation remained free of breast tumor at 5 years, when breast radiation was not employed, 72% (p<0.001) were without tumor reoccurrence. In positive-node patients, 98% of those radiated remained tumor free, whereas only 64% of those receiving no radiation were free of tumor although both groups received chemotherapy. While the clinical significance of these findings is obvious, their biological importance has received less attention. When considered in conjunction with other laboratory and clinical investigations, they lend no support for the anatomic and mechanistic precepts that have dictated thinking relative to metastasis production and have influenced surgical thinking. Clinical issues have arisen as a consequence of the 2 studies, particularly the second. Should a mastectomy be performed when lumpectomy specimen margins are involved with tumor? How should tumor reoccurrence in the ipsilateral breast following lumpectomy be managed? Can lumpectomy be employed for subareolar tumors or for tumors ≥4 cm? How extensive need radiation therapy be following lumpectomy? We have commented on all of these issues and have presented our current thinking regarding the management of patients in whom they arise.     

High Volumetric Breast Density Predicts Risk for Breast Cancer in Postmenopausal,but not Premenopausal,Korean Women

Purpose

We investigated the association between mammographic breast density and breast cancer risk in Korean women according to menopausal status and breast cancer subtypes.

Methods

We enrolled 677 patients diagnosed with breast cancer and 1,307 healthy controls who participated in screening mammography at the National Cancer Center. Breast density was estimated using volumetric breast composition measurement.

Results

Of the total population, 1,156 (58.3 %) women were postmenopausal. The risk of breast cancer increased progressively with the increment of volumetric density grade (VDG) in postmenopausal women (p < 0.001). High breast density (VDG 4) was significantly associated with breast cancer compared with low breast density (VDG 1/2) regardless of body mass index. However, the association with parity and history of hormone replacement therapy (HRT) was only found in those with ≥2 children and those not receiving HRT. Breast density was positively associated with breast cancer risk regardless of histologic grade, tumor size, lymph node involvement, Ki67 index, and hormone receptor status. The association was more prominent in human epidermal growth factor receptor 2 (HER2)-positive tumors (VDG 1/2 vs. VDG 4 for HER2 normal, odds ratio [OR] 2.21, 95 % confidence interval [CI] 1.28–3.83, p < 0.001; for HER2 positive, OR 8.63, 95 % CI 3.26–22.83, p = 0.001; P _{heterogeneity} = 0.030). However, no significant association was found between breast density and breast cancer risk in premenopausal women except for those with large-sized tumors (>2 cm) and a Ki67 index >15 %.

Conclusion

High volumetric breast density is significantly associated with the risk of breast cancer in postmenopausal women; however, these relationships were not found in premenopausal women.     

CSA vs. CSE bei Patienten in der Unfallchirurgie Die kombinierte Spinal-Epiduralanästhesie bietet technisch keine Vorteile gegenüber der Spinalanästhesie mit Mikrokatheter

In this prospective study we investigated the efficacy of microcatheter spinal anaesthesia in comparison with a combined spinal-epidural technique in trauma patients. Methods: After institutional approval 60 patients undergoing urgent lower-limb surgery randomly received either CSA (22 G Sprotte needle, 28 G nylon catheter) in group 1 or CSE (18 G Tuohy needle, 22 G epidural catheter and 25 G pencil-point needle) in group 2. An initial subarachnoid bolus of 2?ml of plain bupivacaine 0.5% was injected in both groups. Difficulties with the lumbar puncture or catheter insertion, the time required for performance of either technique and the onset of analgesia at T12 were documented. If analgesia did not reach T12 within 20?min, supplemental bupivacaine was injected either intrathecally or epidurally up to a maximum of 5?ml in the CSA group or 16?ml in the CSE group. Results: The number of lumbar punctures (CSA: n=1.8±1.5; CSE: n=2.6±1.8; P=0.05) and the incidence of technical problems (CSA: 13%, CSE: 47%; P=0.012) was higher in the CSE group. In contrast to CSA, performance of CSE was more time consuming (CSA: 8±3?min, CSE: 15±8?min; P=0.0003), and the total dose of local anaesthetics was higher in the CSE group (CSA: 3.2±1?ml, CSE: 9.7±5?ml; P<0.0001). Conclusions: Because of the higher incidence of technical problems, more time was required for the performance of CSE. As a consequence, microcatheter CSA might be preferred over CSE in trauma patients.     

Grundlagen und Operationstechnik der T(ibio)-F(ibularen)-Plastik zur Knorpelknochentransplantation

Background. Within the last few years autologeous cartilage-bone-grafting is becoming an established standardized procedure in joint surgery. One significant disadvantage of this technique is the harvesting of the bone plugs from the weight-bearing area of the knee joint. Purpose. The tibiofibular articulation is located close to the knee joint that is operated on. This articulation is covered with cartilage. The purpose of this study was to evaluate the question, whether this joint is suitable as a donor site for bone-cartilage transplants. Material and methods. Favourable approaches and committing of anatomical landmarks were investigated on 44 fixed tibiofibular joints. In knee extension, the shortest distance between the joint cleft and common fibular nerve was measured. The cartilage thicknees and histology of both the fibular and tibial joint surface were documented. The developed surgical approach was evaluated in patients. Results. Histological and immunohistochemical examination showed hyaline cartilage and type II collagen. The average cartilage thickness was 1.9±0.29 mm (minimum: 1.5 mm; maximum: 2.6 mm). The peroneal nerve showed an average distance to the tibiobibular joint of 24 mm (minimum: 12 mm; maximum: 30 mm). Different surgical procedures are possible and clinical relevant. Clinical relevance. The tibiofibular joint contains cartilage, which may be a reasonable donor site even for the elderly patient. Harvesting the graft from this area may avoid iatrogenic damaging of intraarticular weight bearing cartilage of the knee joint.     

Laparoscopic TME with APPEAR (Anterior and Perineal PlanE for ultra-low Anterior Resection of the Rectum) technique for distal rectal cancer

Background

Laparoscopic sphincter saving rectal resection for low rectal cancer is hampered by narrow pelvis and limitations of current stapling devices [1]. The APPEAR (Anterior Perineal PlanE for Ultra-low Anterior Resection of the Rectum) was proposed by Williams et al. [2, 3] as an alternative to the abdominal-perineal resection to perform very low rectal resection and anastomosis through a perineal wound. We adapted the original technique to the laparoscopic approach, avoiding any other abdominal incision.

Methods

Between December 2011 and April 2012, five patients (2 females; median age 72 years (range 60–78)) with rectal cancer not involving the sphincters underwent laparoscopic total mesorectal excision (TME) with APPEAR. Mean distance of the tumor from anal verge was 3.2 ± 1.1 cm (range 2–5).

Results

All of the procedures were completed laparoscopically. All of the anastomoses were stapled, and a protective stoma was always constructed. The surgical specimens were retrieved from the perineal wound, and the stoma performed through one of the port sites, without any further abdominal incision. Mean operative time was 333 ± 47 min (range 295–405), postoperative stay 12 ± 5 days (range 6–17). Perineal wound infection was observed in three patients, two of whom also had anastomotic fistula, and was treated conservatively with prolonged suction drainage. Histological examination showed three pT3N+, one T2N0, and one complete response after neoadjuvant radiochemotherapy, with a mean distal clear margin of 1.27 ± 0.5 cm (range 0.5–1.7). After a median follow-up of 9 months (range 8–12), one stoma reversal has been performed and the patient is fully continent.

Conclusions

Our experience shows the feasibility of the APPEAR technique with laparoscopic TME, without any other abdominal incision. This technique offers advantage over the limitations of current laparoscopic stapling devices and their scanty maneuverability in the pelvis, allowing resection and anastomosis under direct vision, with adequate distal clearance, while sparing the anal sphincters.     

Muskuläre Sauerstoffspannung und nervale Impulsfortleitung bei Einsatz der Antischockhose Verminderung der Sauerstoffspannung im M. tibialis anterior und Einschränkung der Impulsfortleitung im N. peronaeus profundus infolge pneumatischer Druckeinwirkung durch Antischockhose

Object of the study: The aim of the study was to assess, whether the pneumatic pressure of an antishock-trouser (AST) of 20–40?mm?Hg induces a decreased oxygenation of the anterior tibial muscle and attenuates muscular response potential (MRP) of n. peronaeus profundus? Methods: Among 22 normotensive, healthy volunteers the AST were tested by applying pressure values between 0 and 100?mm?Hg and measuring the intracompartmental pressure, the muscular oxygen pressure as well as the MRP by electroneurographic means within a period of 6 hours. Results: The median initial intracompartmental pressure value of the m. tibialis anterior was 12.0?mm?Hg (Q_25%/Q_75%: 8.9/17.3), the muscular oxygen pressure 14.8?mm?Hg (Q_25%/Q_75%: 11.5/22.0). Transmission of the pneumatic AST-leg segment pressure to the muscle: 97.7% (Q_25%/Q_75%: 89.2/99.8). Already in the low AST pressure field (20–40?mm?Hg) a severe hypoxia occurred in one case. A reduction of MRP was noticed at an AST pressure rate of 10?mm?Hg. In 5 of 6 cases AST pressure values of 60?mm?Hg led to pathological pO₂-values within 5–20?minutes. Almost without exception AST-pressure rates Conclusions: We should demand that the AST are only applied with models where the pressure generated within the single segments can be controlled by pressure gauge. The application of the AST seems to be justified for polytraumatised in severe haemorrhagic shock where the risk of a local tissue ischemia with systemical consequences must deliberately be accepted.     

Retrospektive Analyse von transpulmonal und pulmonalarteriell gemessenem Herzzeitvolumen bei ARDS-Patienten

Objectives: To investigate the agreement (and its potential dependency on extravascular lung water) between transpulmonary (TPID) and standard pulmonary artery (PAID) thermodilution cardiac output measurements. Methods: One hundred and sixty simultaneous cardiac output measurements using transpulmonary and pulmonary artery thermodilution techniques were retrospectively compared in 18 patients with acute respiratory distress syndrome. In addition, extravascular lung water was determined using a double indicator technique (temperature and indocyanine green). Results: Mean (±SD) difference (’’bias’’) was 0.03?L/min (±1.04?L/min), linear regression analysis resulted in TPID=0.87 PAID+1.16 (r=0.91). Mean extra vascular lung water was 1625?mL (minimum–maximum: 403–3266?mL) and therefore markedly elevated as could have been expected in patients with ARDS. Bias (PAID-TPID) was not dependent on extravascular lung water. Conclusions: Transpulmonary and pulmonary artery thermodilution methods can be used interchangeably. The results demonstrate for the first time in humans that transpulmonary thermodilution provides valid cardiac output values in patients with markedly increased fluid content of the lungs.     

Evaluation of a new large animal model for controlled intracranial pressure changes induced by capnoperitoneum

Background

A standardized large animal model for controlled ICP manipulation within a relevant range and repetitive ICP measurements is missing. We sought to develop such a model on the base of controlled IPP changes induced by capnoperitoneum.

Methods

We utilized six female pigs (mean body weight 59.5?±?18.4 kg) for experiments. A ventricular catheter connected with a burr hole reservoir was implanted. ICP was measured directly as cm H₂O within a riser tube after percutaneous cannulation of the reservoir. A noninvasive intraperitoneal pressure (IPP) measurement was established (intravesical). Animals were placed in lateral position and a capnoperitoneum was induced. Measurements of ICP, IPP, MAP and respiratory parameters were performed at baseline IPP and after CO₂ insufflation to IPP levels of 20 and 30 mmHg.

Results

Baseline IPP in lateral position referenced to median line was 9.8 (±2) mm Hg, while corresponding ICP was 10 (±2.2) mm Hg. After IPP elevation to 20 mmHg, ICP increased to 18.8 (±1.9) mm Hg. At 30 mmHg IPP, ICP increased to 22.8 (±2.8) mm Hg. Except peak airway pressure, all other parameters were kept constantly. Mean ICP variation in the individual subject was 13.4 (±2.5) mm Hg, while a ICP range from minimum 9 to maximum 31 mmHg was documented.

Conclusions

We report a large animal model that allows (1) repeated measurement of the ICP and (2) manipulation of the ICP within a large pressure range by controlled IPP changes due to capnoperitoneum.     

Increasedl-arginine transport in a nitric oxide-producing metastatic colon cancer cell line

Background: Little is known about amino acid transport in human neoplastic cells. We previously characterizedl-arginine transport in the primary human colon cancer cell line, SW480, and found it is principally mediated by the sodium-independent system y⁺. In this study, we characterizedl-arginine transport in the metastatic cell line, SW620, and compared it with that in the primary cell line, SW480. Methods: Transport of³H-l-arginine in cell monolayers was analyzed in the presence and absence of sodium. Kinetic studies were performed over a range ofl-arginine concentrations to determine transporter affinity (K_m) and maximal transport velocity (V_max). Transport was further characterized through blockade with known amino acids. In addition, the effect of cell age (i.e., time in culture) on arginine transport was examined at 2 and 9 days after seeding. Cellular proliferation was asssessed by using the colorimetric 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay. Results: l-Arginine uptake was primarily sodium independent in the SW620 cell line. Kinetic and amino acid-inhibition studies revealed a single high-affinity, sodium-independentl-arginine transporter (V_max=1286.3 ± 158.3 pmol/mg protein/30 s; K_m=46.8 ± 4.2 μM). Sodium-independent transport was blocked by system y⁺ substratesl-homoarginine,l-ornithine andl-lysine. Sodium-dependent uptake occurs through a single transporter with system B^O,+ characteristics (K_m=16.15 ± 2.1 μM; V_max=329.94 ± 29.7 pmol/mg protein/30 s). Arginine transport increased with time in culture with day 2 cells transport velocity =241.7 ± 33.6 pmol/mg protein/30s, whereas day 9 cells transport velocity =377 ± 15.4 pmol/mg protein/30 s (p<0.01). Cellular-proliferation studies revealed a doubling time of 3.2 days for SW620 and 5.4 days for SW480 (p<0.05). Conclusions: l-Arginine transport in these neoplastic cell lines occurs primarily through sodium-independent, high-affinity system y⁺. V_max was increased 180% in the metastatic variant (SW620), suggesting upregulation of the y⁺ transporter. The increased y⁺ activity may be a mechanism to provide continuous substrate for tumor growth.     

Single centre clinical study of a Greek patient population with triple-negative breast cancer

Aim

The aim of this study is to describe the characteristics of triple-negative breast cancer (TNBC) among patients of a Greek population and investigate the extent to which international TNBC patterns apply to the particular ethnic group.

Material and methods

In this single-centre, retrospective study, medical records of 1455 female patients undergoing breast cancer surgery from 1999 to 2013 were examined in order to identify TNBC patients and evaluate their clinicopathologic characteristics.

Results

In total, 91 TNBC patients (6.3%) were identified, with a median age of 50 years, 91.2% of whom had high-grade tumours. Only nine relapses and four deaths occurred during the study period. Overexpression of Ki-67 and p53 was observed in 95.5% and 76.8% of cases, respectively. Significant correlation was found between relapse and age at first breast surgery (p-value = 0.007) and also between Ki-67 and lymph vessel metastasis (p-value = 0.02).

Conclusions

Our study revealed that in this specific population of Greek patients with breast cancer, TNBCs are characterized by aggressive prognostic factors such as increased expression of Ki-67, EGFR, mutations of p53, high grade and presence of metastatic disease to the regional lymph nodes with concomitant lymph vessel dissemination. The relationship between young age and TNBC reported in other international studies was not observed here. On the other hand, it seems that there is a strong correlation between age at first diagnosis and age at the time of relapse.     

Diagnosing childhood tumors: A review of 147 cutting needle biopsies in 110 children

Background/Purpose: The aims of this study were to evaluate the diagnostic accuracy and safety of cutting needle biopsy for diagnosis in children with tumors suspected for malignancy. Methods: Medical records and biopsy slides recorded from 1988 to 1999 were reviewed. One hundred ten patients had undergone a total of 147 cutting needle biopsies. The biopsy was performed under ultrasound guidance, using a 1.2-mm (18 gauge) Biopty-cut biopsy needle. The diagnoses were benign tumors (n = 8), malignant tumors (n = 84), and nonneoplastic diseases (n = 18), with repeat biopsy performed in 24 patients. Results: The diagnostic accuracy of cutting needle biopsies was 89% (131 of 147). The accuracy for pretreatment diagnosis was 88% (102 of 116), and for confirming or excluding a recurrence or metastasis 93% (26 of 28). The sensitivity of this method was 82% (86 of 105), and the positive predictive value 99% (86 of 87). Nondiagnostic cutting needle biopsy (n = 16) was not related to the age of the patient, experience of the radiologist, number of needle insertions, or site of puncture. No patient exhibited tumor growth along the needle tract. Complications occurred in 10 cases (7%) and pain in 20 (14%). Conclusion: Cutting needle biopsy is an accurate and safe procedure with a low learning threshold that is recomended for diagnosing malignancies in childhood.     

Fluorescence Detection of Malignant Liver Tumors using 5-Aminolevulinic Acid-Mediated Photodynamic Diagnosis: Principles,Technique, and Clinical Experience

Background

Photoactive drugs selectively accumulate in malignant tissue specimens and cause drug-induced fluorescence. Photodynamic diagnosis (PDD) and fluorescence can distinguish normal from malignant tissue.

Objective

Methods

From May 2012 to September 2013, a total of 70 patients underwent hepatic resections using 5-ALA-mediated PDD for liver tumors at our hospital.

Results

5-ALA fluorescence was detected in all hepatocellular carcinoma cases with serosa invasion. In liver metastasis from colorectal cancer cases with serosa invasion, 18 patients (85.7 %) were detected, and three patients (14.2 %) whose tumors showed complete response to neoadjuvant chemotherapy showed no fluorescence. Both superficial and deep malignant liver tumors were detected with 92.5 % sensitivity. Using 5-ALA-mediated PDD, tumors remaining at the cut surface and postoperative bile leakage were less frequent than in our previous hepatic resections using conventional white-light observation. Moreover, all malignant liver tumors were completely removed with a clear microscopic margin using 5-ALA, with a significant difference in resection margin width between 5-ALA-mediated PDD (6.7 ± 6.9 mm) and white-light observation (9.2 ± 7.0 mm; p = 0.0083).

Conclusions

With the detection of malignant liver tumors, residual tumor and bile leakage at the cut surface of the remnant liver were improved by PDD with 5-ALA. This procedure may provide greater sensitivity than the conventional procedure. Furthermore, 5-ALA-mediated PDD can ensure histological clearance regardless of the resection margin and preserve as much liver parenchyma as possible in patients with impaired liver function.     

Der neuroprotektive Einfluss des Glutamat-Antagonisten Acamprosat nach experimenteller zerebraler Ischämie Ein Vergleich mit dem Lipidperoxidase-Inhibitor U-101033E

Introduction. This study investigates the effects of acamprosate, a glutamatergic modulator, and the lipid peroxidation inhibitor U-101033E on neurological outcome following incomplete cerebral ischemia and reperfusion in rats. Material and methods. Twenty-seven male Sprague-Dawley rats were randomly assigned to one of the following treatment groups: 1 (n=9, control, no drug treatment), 2 (n=9, 2×200 mg/kg acamprosate ip), and 3 (n=9, 2×0.3 mg/kg U-101033E iv). Background anesthesia was maintained using a combination of fentanyl and O₂/N₂O (FiO₂=0.3). Ischemia was produced by combined unilateral common carotid artery ligation and hemorrhagic hypotension to a mean arterial blood pressure (MAP) of 35 mm Hg for 30 minutes. Functional neurological deficit was evaluated for the following 3 days after cerebral ischemia. Results. At the third postischemic day, five control animals and five animals treated with U-101033E were dead for stroke-related reasons. Surviving animals presented severe neurological deficits. In contrast, acamprosate improved neurological outcome, with stroke-related death occurring in one animal only and a minor neurological deficit in the surviving rats. Discussion. The present study demonstrates that acamprosate, in contrast to U-101033E, significantly reduces neurological deficits following transient hemispheric ischemia. The neuroprotective mechanisms of acamprosate may be related to its antiglutamatergic effect with consecutive reduction of transmembraneous Ca⁺⁺ flux through NMDA-activated ion channels.