Risk Factors for Recurrence and Death After Primary Surgical Treatment of Malignant Phyllodes Tumors

Background: Malignant phyllodes tumor (MPT) is a rare but aggressive breast malignancy. The aim of this study was to evaluate parameters that influence outcome in patients with MPT.Methods: Fifty women were diagnosed with MPT of the breast and treated between August 1971 and July 2000. All medical records were reviewed retrospectively. The Cox regression model was used for multivariate analysis.Results: Tumors were classified as borderline (6%), low grade (32%), or high grade (62%). The median patient age was 46 years (range, 14–77 years). The median tumor diameter was 3.5 cm (range, 1.5–18 cm). Twenty-two patients had wide local excision (WLE), and 28 patients had mastectomy. The median follow-up was 91 months (range, 12–360 months). Local recurrence (LR) occurred in 16 patients (32%) an average of 26 months after surgery (median, 17 months; range, 3–72 months). Distant metastasis occurred in 13 patients (26%) at an average of 53.4 months (median, 36 months; range, 4–177 months). Sixteen (32%) patients have died of their disease. LR was significantly increased with stromal overgrowth (P < .0001), large tumor size (P = .0177), and surgical margins <1 cm (P = .0120), but not with WLE (P = .5099). Stromal overgrowth was the only independent variable predictive of systemic metastasis (P < .0001) and patient survival (P < .0001).Conclusions: Stromal overgrowth in MPT carries a grave prognosis. Close surgical margins and large tumor size, but not type of operation, significantly increased LR. Either WLE with adequate margins or mastectomy is an appropriate treatment for patients with MPT.     

Urethral cultures in patients with spinal cord injury

STUDY DESIGN: Prospective analysis. OBJECTIVES: To investigate the colonization of the distal urethra and bladder during the initial stages of rehabilitation in acute spinal-cord injury (SCI) and to examine the association between bacteriuria and colonization of the distal urethra. SETTING: Selcuk University Meram Faculty of Medicine, Konya, Turkey. METHODS: A total of 27 patients with SCI (13 females and 14 males) and 40 controls without evidence of disease of the urinary tract were studied. Cultures were taken from the patients who applied clean intermittent catheterization and compared with normal subjects. RESULTS: Escherichia coli was predominantly isolated from the urine and urethral cultures of both female and male SCI patients. Colonization of other bacteria in the urine and urethral cultures was similar in both female and male patients, except for Pseudomonas, which was colonized in male patients. In all, 72% of patients who had E. coli positive urethral cultures also had E. coli colonization in their simultaneous urine cultures. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.82). When urethral cultures collected 1 week before were evaluated in patients with E. coli positive urine cultures (n=24 cultures), 15 of these urethral cultures also had E. coli colonization. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.66). CONCLUSIONS: Our study suggested that urethral flora was a significant source for the development of urinary infection in spinal cord-injured patients.     

Low dose systemic thrombolytic therapy for treatment of deep venous thrombosis

BACKGROUND: Thrombolytic therapy is still not used widely for treatment of deep vein thrombosis despite its known efficacy. This reluctance to use it stems from worries about its hemorrhagic complications. METHODS: In a 4-year period 97 patients with deep vein thrombosis diagnosed by duplex study were enrolled into the study. Fifty patients received streptokinase as a bolus of 250,000 units followed by 100,000 units/hr with a maximum of 4,000,000 units and 47 patients received anticoagulation with heparin. RESULTS: Minor hemorrhagic complications occurred in 2 patients (4%) in the thrombolytic therapy group. An improvement in the control duplex study was observed in 56% of the patients in the thrombolytic therapy group compared to 5% in the heparin group (p=0.000). The patients treated within 4 days of onset of symptoms had significantly higher success rates compared to those treated later (p=0.000). Higher success rates were obtained for those with either femoral vein or more distal venous thrombosis compared to those with iliac vein and vena cava thrombosis (p=0.007). These results show that systemic low dose streptokinase achieves significantly higher recanalization rates compared to heparin alone. CONCLUSIONS: Hemorrhagic complications at these dose levels are within acceptable ranges. Low dose streptokinase regimen could be beneficial in patients who present within 4 days of femoral or more distal venous thrombosis.     

Prognostic implications of microscopic proximal bronchial extension in non-small cell lung cancer

BACKGROUND: The loss of approximately one third of early stage lung cancer patients undergoing complete resection by the end of 5 years implies the existence of unknown or undetected factors at the time of operation. We investigated the possible correlation between microscopic proximal bronchial extension (MPBE) and survival with clinicopathologic features in patients with non-small cell lung cancer. METHODS: The bronchial tree with the tumor was dissected and extracted from the lung parenchyma in a total of 62 surgical specimens with non-small cell lung cancer. The tumor-related bronchus was sectioned into serial blocks at a thickness of 5 mm in the transverse plane. Histologically, cut serial sections were examined for MPBE. RESULTS: A total of 15 (24.2%) specimens showed MPBE, whereas 47 (75.8%) specimens showed no evidence of MPBE. The median survival time of MPBE-positive patients was 10.0 months, whereas that of MPBE-negative patients was 42.0 months. The 5-year survival rates of MPBE-positive and MPBE-negative groups were 13.3% and 35.8%, respectively, which was a significant difference (p = 0.0203). Multivariate analysis revealed lymph node status (p = 0.0161), histology (p = 0.0268), and MPBE-positivity (p = 0.0447) as independent prognostic factors. CONCLUSIONS: Microscopic proximal bronchial extension has an adverse effect on survival in non-small cell lung cancer.     

Endothelial function in pigs transgenic for human complement regulating factor

BACKGROUND: Expression of human complement regulating factor (hCRF) in porcine organs prevents hyperacute rejection of these organs after xenotransplantation to nonhuman primates. Experiments were designed to characterize endothelial and smooth muscle function of arteries from pigs transgenic for hCD46. METHODS: Arterial blood from outbred pigs transgenic for hCD46 expression and nontransgenic animals of the same lineage was analyzed for angiotensin-converting enzyme (ACE), C-type natriuretic peptide (CNP), and nitric oxide. Aortic endothelial cells were prepared for measurement of mRNA or activity for nitric oxide synthase (NOS). Rings cut from femoral and pulmonary arteries were suspended in organ chambers for measurement of isometric tension. RESULTS: CNP was significantly greater, ACE was similar, and nitric oxide was significantly less in plasma from transgenic compared with nontransgenic pigs. Neither mRNA nor activity of NOS differed between the groups. Endothelium-dependent relaxations to bradykinin and acetylcholine but not the calcium ionophore were shifted significantly to the left in femoral and pulmonary arteries from hCD46 transgenic pigs compared with nontransgenic pigs. The ACE-inhibitor captopril augmented relaxations similarly in both groups, but NG-monomethyl-L-arginine (L-NMMA) did not inhibit relaxations in rings from transgenic pigs. CONCLUSIONS: Data suggest that expression of hCD46 on endothelium of pigs selectively augments endothelium-dependent relaxations to bradykinin by increased release of endothelium-derived factors other than nitric oxide. There does not seem to be any change in activity of ACE or NOS with expression of the human protein. Increased relaxations to bradykinin may be beneficial in lowering vascular resistance when transgenic organs are used for xenotransplantation.     

Clinical and functional results of radiofrequency ablation and microwave ablation in patients with benign thyroid nodules

Objectives:To determine how well ultrasound-guidance percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) performed for benign symptomatic thyroid nodules in terms of clinical and functional outcomes.Methods:Patients who had a thyroid nodule-linked symptoms acting as dysphagia, cosmetic issues, pain, a foreign body sense, hyperthyroidism secondary to autonomous nodules, or concern of malignancy were involved in the study. The primary was the comparison in symptom scores obtained at 1, 3, and 6 months after RFA and MWA. The volume alterations in nodules and alterations in thyroid gland functions were secondary objectives.Results:This prospective study carried out from November 2014 and January 2017 at the General Surgery Department, Marmara University, Faculty of Medicine, Istanbul, Turkey included a total of 100 nodules (50% MWA, 50% RFA). There were statistically significance in pain scores, dysphagia scores, and foreign body sensation scores at 1, 3, and 6 months after therapy in both ablation groups (p=0.0006, p=00004, p=0.0005). At the same time, there were statistically significant reductions in size and volume of the nodules for RFA and MWA (p=0.0004, p=0.0003). There was no significant difference between the RFA and MWA groups’ cosmetic scoring and volume changes (p=0.68, p=0.43).Conclusions:Alternative therapies for benign symptomatic thyroid nodules include RFA and MWA. The findings of this research revealed that both approaches are safe and effective.     

Atherosclerosis in Takayasu arteritis

OBJECTIVE: Chronic inflammatory diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis are associated with accelerated atherosclerosis. We hypothesised that atherosclerosis may also be increased in Takayasu arteritis. METHODS: The frequency of atherosclerotic plaques and the intima-media thickness (IMT) were investigated in 30 female patients with Takayasu arteritis (mean age (standard deviation), 35.4 (8.0) years), along with 45 sex-matched and age-matched patients with SLE (37.4 (6.8)) and 50 healthy controls (38.2 (5.7)). Plaques were scanned and IMT was measured at both sides of the common carotids, carotid bulb, and internal and external carotid arteries by B-mode ultrasonography. Traditional risk factors for atherosclerosis were also assessed. RESULTS: Most of the atherosclerotic risk factors were comparable between patients with Takayasu arteritis and SLE. More atherosclerotic plaques were observed among patients with Takayasu arteritis (8/30; 27%) and those with SLE (8/45; 18%) than among the healthy controls (1/50; 2%; p = 0.005). Logistic regression analyses showed that the presence of a plaque was associated only with age in both Takayasu arteritis and SLE (p = 0.04 and 0.02, respectively). The mean overall IMT was significantly higher among patients with Takayasu arteritis (0.95+/-0.31 mm) than among the patients with SLE (0.58+/-0.10 mm) and the healthy controls (0.59+/-0.08 mm; p<0.001). CONCLUSION: Patients with Takayasu arteritis have a high rate of atherosclerotic plaques, at least as frequent as that observed among patients with SLE.     

Effect of Nifedipine on the Healing of Left Colonic Anastomoses in Rats

Purpose Ca²⁺ channel blockers inhibit collagenase production and have a vasodilatatory effect. They also restrict the formation of ischemia-reperfusion induced free oxygen radicals. The aim of this study was to assess the effect of nifedipine on the healing of colonic anastomoses in a rat model.Methods Sixty Wistar rats weighing 240–290g were divided into four groups of 15 rats each: a 3rd day control group (group A), a 3rd day treatment group (group B), a 7th day control group (group C), and a 7th day treatment group (group D). The treatment groups were given Nifedipine 3mg/kg per day orally as three divided doses.Results The bursting pressure values of the anastomoses in the treatment groups were significantly higher than those in the control groups (P 0.05). The hydroxyproline content was also significantly higher in the treatment groups than in the control groups (P 0.05). Histologic examination confirmed that nifedipine treatment significantly increased collagen deposition and fibroblast ingrowth compared with controls (P 0.05).Conclusions These results clearly showed that nifedipine enhanced the stability of colonic anastomoses during the first postoperative week.     

Spinal epidural abscess associated with IgG4 deficiency

The objective is to present the possibility of an association between spinal epidural abscess and IgG deficiency. Spinal epidural abscess is a rare but potentially devastating condition. Review of the literature showed no reported acknowledgment about the relationship between spinal epidural abscess and IgG deficiency. This report discusses the case of a 16-year-old boy who developed progressive paraplegia within 24 hours. Clinical and neuroradiologic features are reported. Serum quantitative total IgG, IgA, and IgM concentrations were measured by nephelometry. Thoracic magnetic resonance imaging showed epidural abscess between T6 and T11 compressing the cord posteriorly. IgG subclasses (IgG ) were found abnormal. The possible importance of immunologic evaluation in the patients with spinal epidural abscess when no source of infection could be find is discussed.(4) (4) (4)     

Dissection of the ascending aorta due to metastatic carcinoma

The association of aortic dissection with a malignancy is a rare finding and previous reports are usually those of primary aortic sarcomas. In this report we present a case with typical ascending aorta dissection associated with metastatic carcinoma originating from the lungs. The metastatic infiltration of the vasovasorum of the aorta by carcinoma cells may have caused aortic dissection by decreasing medial strength and integrity. This is a mechanism of aortic dissection that we have not encountered in previous reports.