Assessment of highly angiogenic and disseminated in the peripheral blood disease in breast cancer patients predicts for resistance to adjuvant chemotherapy and early relapse

The assessment of tumor molecular features in combination with the detection of occult malignant cells may provide important clinical information, beyond the standard staging of breast cancer. Using a nested RT-PCR technique, we assessed prospectively the presence of cytokeratin-19 (CK19) mRNA positive cells in the blood of 100 operated patients with breast cancer before the initiation of adjuvant chemotherapy and local radiotherapy. Tissue samples were prospectively collected and analyzed for estrogen (ER) and progesterone (PgR) receptor, c-erbB-2 overexpression, mutant-p53 and bcl-2 protein accumulation, proliferation index and microvessel density (MVD). CK-19 mRNA-positive cells were detected in the peripheral blood of 33% of patients. Simultaneous display of high intratumoral MVD and of CK-19 mRNA-positive cells, which characterized highly angiogenic and disseminated in the peripheral blood (HAD) disease was noted in 25% of patients. Detection of CK-19 positive cells was significantly associated with increased MVD (p = 0.002). In univariate analysis (median follow-up 30 months) CK19 mRNA detection and MVD were the most significant factors related to a short relapse-free survival (RFS), (p < 0.0001). In multivariate analysis, CK19 positivity, high MVD and c-erbB-2 overexpression were the only significant and independent variables associated with relapse (p = 0.0005, 0.03 and 0.04, respectively). Patients with HAD had an expected relapse rate close to 70% vs. <5% in the remaining patients irrespectively of the used chemotherapy regimen. The simultaneous presence of high MVD and CK19-positive cells in the blood of patients with early breast is linked with poor prognosis, which cannot be improved with standard chemotherapy regimens.     

Serum CA 125 combined with transvaginal ultrasonography for ovarian cancer screening

BACKGROUND: The aim of this study was to evaluate the combination of serum CA125 and Transvaginal Ultra Sonography (TVUS) score, as a screening procedure for ovarian cancer in premenopausal and postmenopausal women. PATIENTS AND METHODS: A retrospective case-control pilot study was conducted. The files of 120 women with ovarian neoplasia detected by TVUS and increased CA125 level, within the framework of a prevention program, were reviewed. The relationship between the above tests and epithelial malignancy was investigated using the SPSS-12 program for Windows. RESULTS: The combination of CA125 value exceeding 30U/ml and a TVUS score > or = 35 had a sensitivity of 81.7% and specificity of 100% in predicting ovarian cancer. Mathematical analysis of the logistic model of our variables revealed a mathematical model that can calculate the likelihood of ovarian cancer detection, by using a combination of CA125 > or = 30U/ml and TVUS score > or = 35. CONCLUSION: By combining TVUS and CA125, an accurate prediction for the presence of ovarian cancer may be achieved. Further investigation in a larger population is warranted.     

The angiogenetic effect of intramuscular administration of VEGF on muscle. The influence of exercise on angiogenesis

Although angiogenetic therapy using recombinant growth factors holds much hope for the treatment of ischemic diseases, there are still unanswered questions including the method, doses or duration of therapeutic approach. We evaluated the angiogenetic effects of vascular endothelial growth factor (VEGF) on rat heart and gastrocnemius muscles when this was administered intramuscularly and compared them to those obtained from rats, which exercised daily. CONCLUSION: Both daily swimming exercise and intramuscular administration of VEGF increased angiogenesis in rat heart, even though exercise alone was the only one that increased angiogenesis quite significantly. The combined protocol (administration of growth factor and exercise) led to an increase of angiogenesis in cardiac muscles. In contrast, there was no effect on the lateral gastrocnemius muscle either by VEGF or exercise, whereas these together induced angiogenesis locally at the site of injection.     

Immunohistochemical expression of metalloproteinases MMP-2 and MMP-9 in abdominal aortic aneurysms: correlation with symptoms and aortic diameter

Our purpose was to investigate the expression of matrix metalloproteinase (MMP)-2 and -9 in all types of abdominal aortic aneurysms (AAA): symptomatic, asymptomatic, and ruptured. MMP-2 and -9 activity was investigated in surgical samples from the arterior wall of 46 AAA, using a standard immunohistochemical technique. The MMP-9 activity was significantly higher in large AAA (>6 cm), but there was no relation between AAA size and MMP-2 activity. Neither MMP-2 nor MMP-9 were related with AAA rupture, other complications or symptoms. The MMP-9 activity in AAA is a determinant of the aneurysm size, but it is not related to clinical manifestations.     

Primary diffuse large B-cell lymphoma of the breast: a case report.

Mammary non-Hodgkin's lymphomas are uncommon and account for 2% of all extranodal lymphomas. Stringent diagnostic criteria are applied in the diagnosis of primary lymphoma considering that the breast is a recognized site for disseminated extranodal lymphoma. Our case report was established by histology alone.     

Is tension band wiring technique the "gold standard" for the treatment of olecranon fractures? A long term functional outcome study

Background  

Tension band wiring (TBW) remains the most common operative technique for the internal fixation of olecranon fractures despite the potential occurrence of subjective complaints due to subcutaneous position of the hardware. Aim of this long term retrospective study was to evaluate the elbow function and the patient-rated outcome after TBW fixation of olecranon fractures.     

Activated VEGFR2/KDR pathway in tumour cells and tumour associated vessels of colorectal cancer

BACKGROUND: Vascular endothelial cell growth factor (VEGF) acts by phosphorylating specific tyrosine kinase receptors on endothelial cell membrane promoting angiogenesis. The study of the activation status of VEGF receptors in human malignancies has recently become feasible by means of specific monoclonal antibodies recognising the phosphorylated form of these receptors. MATERIALS AND METHODS: In the current study, we investigate the expression of the phosphorylated VEGFR2/KDR receptor in normal colon and colorectal adenocarcinomas in parallel with histopathological parameters, prognosis and the expression of the 'hypoxia inducible factor' HIF1alpha. RESULTS: pVEGFR2/KDR was weakly expressed in the normal colon, but it was expressed strongly in the cytoplasm and nuclei of cancer cells and in the tumour associated vasculature, mainly at the invading tumour edge. pVEGFR2/KDR expression in cancer cells was significantly associated with a tumour diameter > 6 cm (P = 0.04), poor histological differentiation (P = 0.004) and with high CEF1alpha expression (P = 0.05). High pVEGFR2/KDR expressing vascular density was significantly related with a high VEGF and HIF1alpha expression in cancer cells (P = 0.02 and 0.03, respectively). This was also related significantly to high pVEGFR2/KDR expression in cancer cells. In multivariate analysis, the most significant predictors for death were lympho-vascular invasion (P < 0.001) followed by VEGF (P = 0.014), node status (P = 0.015), standard vascular density (P = 0.022) and necrosis (P = 0.032). CONCLUSIONS: pVEGFR2 receptors are largely expressed in colon cancer cells and intratumoural vasculature. As VEGF targeting agents enter the clinical practice, the role of monoclonal antibodies recognising the phosphorylated form of VEGF receptors as predictors of response to targeted therapies should be sought in clinicopathological trials.     

Subcutaneous targeted neuromodulation technique for the treatment of intractable chronic postthoracotomy pain

Subcutaneous targeted neuromodulation has been used successfully in chronic neuropathic pain. A 26 year-old patient with severe postthoracotomy pain and ipsilateral "wing scapula" due to intraoperative injury of the long thoracic nerve, is reported. Application of targeted neuromodulation resulted in immediate pain relief and marked improvement of shoulder function at one-year follow-up. The technique may be an effective alternative treatment of chronic and intractable postoperative painful conditions.