Patients with only 1 positive hormone receptor have increased locoregional recurrence compared with patients with estrogen receptor-positive progesterone receptor-positive disease in very early stage breast cancer

BACKGROUND:

Estrogen receptor (ER) and progesterone receptor (PR) are important prognostic and predictive biomarkers in breast cancer. Patients with tumors positive for either receptor are generally considered hormone receptor‐positive for treatment decisions. However, some data suggest that patients with ER⁺/PR^? or ER^?/PR⁺ tumors may have worse outcomes than those with ER⁺/PR⁺ tumors. Few data correlate these biomarkers with locoregional (LR) recurrence.

METHODS:

The authors retrospectively reviewed records of 635 patients with T1a,bN0 disease who received definitive treatment at their institution between 1997 and 2002 and had archival tissue blocks for prospective assessment of ER/PR expression. They compared clinical outcomes of the 479 patients with ER⁺/PR⁺ disease to the 156 patients with ER⁺/PR^? or ER^?/PR⁺disease.

RESULTS:

LR recurrence rates were higher in patients with 1 receptor positive compared with ER⁺/PR⁺ (7‐year rate: 8.8% vs 2.5%, P = .024). There was no difference between the 2 groups in the rates of distant metastasis (DM) (P = .531) or overall survival (P = .491). One positive receptor predicted for LR recurrence in patients who did not receive hormonal therapy (P = .046), but not in patients who received hormonal therapy (P = .296). On multivariate analysis, 1 positive receptor predicted for LR recurrence in the overall group (hazard ratio, 2.81; 95% confidence interval, 1.06‐7.48; P = .038).

CONCLUSIONS:

Patients with T1a,bN0 breast cancer with only 1 positive hormone receptor have increased rates of LR recurrence compared with patients with ER⁺/PR⁺ disease, although this difference may be reduced or eliminated with systemic treatment. In contrast, the authors found no evidence of an increased rate of DM in these patients with favorable disease stage. Cancer 2011. © 2010 American Cancer Society.     

Traumatic intraventricular hemorrhage with a good prognosis

We report a 10-year-old girl with an isolated traumatic intraventricular hemorrhage following a traffic accident, who had a good prognosis. Her neurological examination upon arrival was normal and she had no complaint other than headache and vomiting. Computed tomography on admission showed a hemorrhage in the lateral and fourth ventricles. She had a Glasgow Coma Score of 15, and she was thus given only antiepileptic drugs for prophylaxis and followed. Computed tomography that was repeated 5 days after admission showed no blood and all ventricles were of normal size. There was no vascular pathology on magnetic resonance imaging and magnetic resonance angiography. The patient remains well 5 months after her accident. Intraventricular hemorrhage does not always have a poor prognosis.     

Assessment of DNA damage in postmenopausal women under osteoporosis therapy

OBJECTIVE: The following study was designed to examine possible DNA damage levels in peripheral blood leukocytes, using the alkaline Comet assay, isolated from postmenopausal women undergoing osteoporosis treatment. STUDY DESIGN: Thirty-two postmenopausal women were randomized into two groups of 16. A dosage of 2.5 mg/day of tibolone (Livial) and 10mg/day of alendronate sodium (Fosamax) were administered to Group 1 over a 12-month period while Group 2 took 10 mg/day of alendronate alone over the same period. The control group consisted of 16 postmenopausal women who did not receive any treatment. Genotoxicity was assessed by the standard method of alkaline Comet assay. RESULTS: When the results of the study groups were compared with those of the control group, significant differences in terms of DNA damage levels were found (p<0.05). However, no difference was detected between Groups 1 and 2 (p>0.05). CONCLUSION: Although, no statistical difference in terms of DNA damage levels between tibolone plus alendronate as opposed to alendronate alone was found, an increase in DNA damage levels was observed in Groups 1 and 2 compared with the control group. Consequently, it can be asserted that the frequency of DNA damage in postmenopausal women with osteoporosis increases under alendronate treatment with or without tibolone.     

Neuron-specific enolase levels as a marker for possible neuronal damage in idiopathic intracranial hypertension

Although formerly considered as a “benign” disease, the presence of some important problems such as vision loss, resistance to appropriate medical treatment and relapses suggests that neuronal damage might play a role in the pathophysiology of IIH. In order to demonstrate possible neuronal damage/dysfunction participating in IIH pathophysiology, we aimed to investigate the relationship between serum neuron-specific enolase (NSE) levels and clinical features in patients with idiopathic intracranial hypertension (IIH). Thirty-six patients with IIH, diagnosed according to the revised criteria, and 40 age, gender and body mass index-matched healthy controls were enrolled in this study after their consent. Serum samples were evaluated for NSE via enzyme-linked immunosorbent assay method. NSE levels were higher in the IIH group (23.7 ± 14.53 ng/ml) compared to the control group (22.7 ± 13.11 ng/ml), but the difference was not statistically significant (p = 0.824). There were also no statistically significant differences in NSE levels in IIH patients regarding the presence of visual loss, relapse, oligoclonal bands and papilledema. We could not demonstrate any correlations between NSE levels and age, body mass index, cerebrospinal fluid opening pressure and disease duration. The present study is the first to analyze NSE levels in IIH patients and showed no significant difference between patients and controls, and also between different clinical subgroups of IIH patients.     

Silent cerebral emboli following percutaneous closure of atrial septal defect in pediatric patients: a diffusion-weighted MRI study

PURPOSE

The aim of this prospective study was to investigate the incidence of silent cerebrovascular embolic events associated with percutaneous closure of atrial septal defect (ASD) in pediatric patients.

METHODS

A total of 23 consecutive pediatric patients (mean age, 10.4±3.8 years; range, 4–17 years) admitted for transcatheter closure of ASD were recruited in the study. The patients were scanned with a 1.5 Tesla clinical scanner. Two cranial magnetic resonance imaging (MRI) examinations were acquired before the procedure and within 24 hours following the catheterization. MRI included turbo spin-echo fluid-attenuated inversion recovery (FLAIR) sequence and diffusion-weighted imaging technique with single-shot echo-planar spin-echo sequence. The transcatheter closure of ASD was performed by three expert interventional cardiologists. Amplatzer septal occluder device was implemented for the closure of the defect. No contrast medium was administered in the course of the procedure.

RESULTS

None of the patients had diffusion restricted cerebral lesions resembling microembolic infarctions on postprocedural MRI. Preprocedural MRI of two patients revealed nonspecific hyperintense white matter lesions on FLAIR images with increased diffusion, which were considered to be older ischemic lesions associated with previously occurred paradoxical embolism.

CONCLUSION

The current study suggests that percutaneous closure of the ASD, when performed by experienced hands, may be free of cerebral microembolization in pediatric patients. However, due to the relatively small sample size, further studies with larger patient groups are needed for the validation of our preliminary results.Acute symptomatic cerebral infarction associated with percutaneous cardiovascular intervention has been reported to have an incidence of 0.09%–1.0% when evaluated solely with neurologic examination (1–4). However, asymptomatic cerebral microemboli detected with transcranial Doppler ultrasonography (US) monitoring and diffusion-weighted imaging (DWI) following either conventional or interventional cardiac catheterization is unexpectedly more common (4–10). The incidence revealed with DWI studies varies between 3.3% and 77% depending on risk factors associated with the patient population and the procedure, in adult studies (9, 10).Due to technologic developments, more children with congenital heart disease are taken to the cardiac catheterization laboratory for interventional treatment. The subclinical focal neurologic events are more difficult to reveal solely with neurologic examination in children compared with the adult age group. Therefore, it is crucial to determine the silent neurologic complications and the risk factors associated with heart catheterization in the pediatric population. There have been a few studies in adults (10–12), but to the best of our knowledge, no clinical studies revealed the association of subclinical ischemic lesions with transcatheter closure of atrial septal defect (ASD) in pediatric patients.Transcatheter closure of ASD, which is an alternative to open heart surgery, is applied as a first-line treatment modality in appropriate patients (13). Despite increasing rates of complete closure with ongoing technologic innovations, neurologic complications associated with peri-interventional cerebral embolism have been reported (10, 11). In this single-center, prospective study, we aimed to investigate the incidence and the risk factors of silent cerebral embolism following transcatheter closure of ASD with the Amplatzer septal occluder (AGA Medical Corp.) device in pediatric patients.     

Cutis laxa-like pseudoxanthoma elasticum with ossification

Pseudoxanthoma elasticum (PXE) is a heritable disorder of elastic fibers characterized by yellowish, coalescing papules on the flexural area, which is loose and wrinkled. A 35-year-old woman presented cutis laxa-like marked wrinkling and yellowish papules, and a skin biopsy revealed ossification and fragmentation of elastic fibers in the dermis. Ophthalmologic examination revealed a peau d'orange appearance of the retina. She was also found to have a mitral stenosis and hypertension. This is an unusual case of concurrent ossification and cutis laxa-like PXE.     

Allopurinol plus pentoxifilline in hepatic ischaemia/reperfusion injury

OBJECTIVES: Ischaemia/reperfusion injury of the liver is the major cause of liver dysfunction and cellular death in transplantation and in liver resection with hepatic pedicle clamping. Many agents are used to prevent this phenomenon, which occurs following interaction of different mediators during both ischaemia and reperfusion. In this study, we aimed to assess the effects of allopurinol, a xanthine oxidase inhibitor, and pentoxifilline, on liver ischaemia/reperfusion injury when used together and to compare these with the effects of using these agents singly. METHODS: Thirty-two rats were divided into four groups consisting of eight rats: Group C, control; Group P, pentoxifilline; Group A, allopurinol; and Group PA, pentoxifilline + allopurinol. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels were measured before hepatic pedicle clamping, on the 45th minute of ischaemia and 15 and 45 minutes after reperfusion. Group P rats were injected with 50 mg/kg pentoxifilline, Group A rats 50 mg/kg allopurinol and Group PA rats were injected with both agents 15 minutes before hepatic pedicle clamping. RESULTS: Ischaemia/reperfusion injury was produced by hepatic pedicle clamping, as demonstrated by AST, ALT and LDH increase. Injury prevention occurred in Groups P, A and PA. No significantly different (better) prevention was provided by giving allopurinol plus pentoxifilline to the rats. Furthermore, no difference was observed between the allopurinol and pentoxifilline injected groups in terms of preventing ischaemia/reperfusion injury. CONCLUSIONS: Pretreatment with allopurinol or pentoxifilline resulted in significantly lower hepatic enzyme elevation than that in controls in the rat liver ischaemia/reperfusion model. Using both agents does not provide better protection than using either agent alone.